A Study On Clinical Efficacy Of Cervical Insufficiency

Objective:Evaluate the effect of different treatments of cervical insufficiency and analyze the risk factors influencing the therapeutic effect through reviewing cases date.Methods:77 cases of cervical insufficiency admitted to tianjin medical university general hospital from June 2012 to December 2018 were included in the analysis.Reviewd cases data and divided the cases into two groups according to the operation or not:operation group and conservative treatment group.What’more,according to the timing of operation,patients was divided into preventive cervical cerclage group,therapeutic cervical cerclage group and emergency cervical cerclage group.Analyze the effects of different treatments of cervical insufficiency.At last,according to treatment effect,patients was divided into the success group(term birth or premature infant survival)and the failure group(late abortion or premature infant death),analyze the risk factors influencing the therapeutic effect.Results:1.Delivery gestational week,full-term delivery rate and neonatal survival rate of the operation group were all higher than those of the non-operation group,and the differences were statistically significant(Z=-3.501,P<0.01;χ~2=4.697,P=0.03;χ~2=8.232,P<0.01).The abortion rate in the operation group was lower than that in the non-operation group,and the difference was statistically significant(χ~2=5.278,P=0.022).2.In preventive cervical cerclage group and therapeutic cervical cerclage,delivery gestational week,full-term delivery rate,neonatal survival rate were higher than conservative treatment group,the abortion rate is lower than conservative treatment group,the difference was statistically significant(P<0.05).3.The delivery gestational week and neonatal survival rate of emergency cervical cerclage were higher than those of the conservative treatment group,and the difference was statistically significant(Z=-2.445,P=0.014;χ~2=5.06,P=0.038).However,the incidence of neonatal sepsis in the emergency cervical cerclage group was higher than that of conservative treatment,and the difference was statistically significant(χ~2=6.50,P=0.03).4.The delivery gestational week,full-term delivery rate of the preventive cervical cerclage group and the therapeutic cervical cerclage group were higher than those of the emergency cervical cerclage group;The abortion rate and premature rupture rate of membranes were lower than those of the emergency cervical cerclage group,with statistically significant differences(P<0.05).However,there were no statistically differences between the preventive cervical cerclage group and the therapeutic cervical cerclage group in terms of delivery gestational week,full-term delivery rate,abortion rate and premature rupture rate(P>0.05).5.There were significant differences between the successful group and the failed group in terms of number of pregnancy,endocrine complications,cervical dilatation width and cervical length(Z=-2.223,P=0.026;χ~2=17.259,P<0.01.;Z=-3.179,P<0.01;Z=-2.551,P=0.011).Conclusion:1.Cervical cerclage can effectively improve the pregnancy outcome of patients with cervical insufficiency.2.Preventive cervical cerclage and therapeutic cervical cerclage is better than that emergency cervical cerclage.However,the effect is no significant difference between each other.When faced patients with only one time history of miscarriage or preterm birth,regularly monitoring cervical length is important.Cervical cerclage is necessary when the cervix was progressively shortened.3.Emergency cervical cerclage may be a remedial measure for patients with dilated cervix but may increase the risk of neonatal sepsis.Use antibiotics when necessary.4.Number of pregnancy,medical complications,the degree of cervical dilatation and the length of the cervix were the possible risk factors for the treatment effect of patients with cervical insufficiency.