Correlation Between Vaginal Microecological Changes During Cervical Cerclage And Pregnancy Outcome

Objective: To explore the effect of vaginal microecology changes on pregnancy outcome in patients with cervical insufficiency treated by transvaginal modified Shirodkar cerclage(High cerclage)and Mc Donald cerclage(Mc cerclage).To guide the management of postoperative vaginal microecology.Methods: Collect the clinical data of patients who underwent transvaginal cervical cerclage between January 2020 and January 2023 at the Jiangxi Maternal and Child Health Hospital.The surgical methods were divided into transvaginal modified Shirodkar cerclage(High cerclage group)and Mc Donald cerclage(Mc cerclage group).After screening by the inclusion and exclusion criteria,a total of249 well-documented cases were included in this study,including 107 cases in the High cerclage group and 142 cases in the Mc cerclage group.To investigate the association between the alteration of vaginal microecology changes during the two different cervical cerclage and pregnancy outcomes by t test,chi-square test and logistic regression analysis.Results: There were differences in the vaginal microecological environment changes between patients during the two types of surgical treatments,mainly indicated that the vaginal microecological environment was more balanced in the Mc cerclage group before cervical cerclage(a small number of epithelial cells,bacilli and leukocytes microscopically),while the bacilli were more dominant in the High cerclage group(P<0.05).During cerclage,the cleanliness changed from I～II to III～IV,the positive rate of leukocyte esterase increased and more mycoplasma infection occurred in the High cerclage group,while the p H value increased and more candida infection occurred in the Mc cerclage group(P<0.05).Before removal of cerclage suture,the number of bacilli was less and the p H value was higher in the Mc cerclage group,whereas the high cerclage group presented microscopically with more leukocytes,poor cleanliness,and leukocyte esterase positivity(P<0.05).Both of the two operations can effectively prolong the gestational age,and in the effect of the Ultrasound-indicated cerclage Mc cerclage group is better than the High cerclage group(P<0.05).Multivariate logistics regression analysis showed that pregnant womon with high BMI or twin pregnancy increases the risk of adverse pregnancy outcome after cervical cerclage,and elevated blood leukocyte counts,vaginal bacilli deficiency and elevated p H at prior to suture removal are risk factors for adverse pregnancy outcome(P<0.05).Conclusion: The modified Shirodkar cerclage and Mc Donald cerclage have their own characteristics of vaginal microecology,and there are differences in the effects of the two operations on vaginal microecology.Except the absence of vaginal bacteria and elevated p H after operation are risk factors for adverse pregnancy outcome,the other changes of vaginal microecology have no significant effect on pregnancy outcome.During cerclage,the two types of operation can achieve ideal pregnancy outcome under the effective management of vaginal microecology,and the modified Shirodkar cerclage shows greater advantages in ultrasound-indicated cerclage.