| Research background and purpose:With the development of assisted reproductive technology,the occurrence of twin pregnancies increases year by year,accounting for 3% of the total pregnancies.The leading complication of twin pregnancies is preterm birth.The incidence of premature birth is as high as 60.32%,6 times that of singleton.Twin premature birth brings a heavier mental and economic burden to society and family than single premature birth,and cervical insufficiency is an important cause of premature birth.It is reported that the probability of cervical insufficiency in twin pregnancy is 7 times that of single pregnancy.Cervical ceration,as the only operative and effective method for the treatment of cervical insufficiency at present,is of great significance for the maintenance of pregnancy.And has been a hot topic of research.In clinical practice,most cervical cirception is emergency cervical cirception,and transvaginal cervical cirception is the most commonly used operation in China.At present,there are many articles on the evaluation of the therapeutic effect of single pregnancy at home and abroad,while there are relatively few studies on the therapeutic effect of cervical cirception for cervical insufficiency in twin pregnancy.The current guidelines do not recommend preventive cervical cirception for twins.However,there is insufficient evidence that cervical ceration is beneficial for reducing preterm birth at <37,<34,and <32 weeks of gestation in twins with cervical canals less than 1.5cm in length.Therefore,based on this,the purpose of this study is mainly to study the evaluation of the treatment of cervical insufficiency in twin pregnancies with cervical canal shortening less than the critical value(the length of cervical canal in twin pregnancies is less than 1.5cm),and to provide relevant clinical data for the emergency cervical ceration of cervical insufficiency in twin pregnancies.Methods:A total of 34 twin pregnant women who underwent emergency vaginal cervical ceration due to cervical insufficiency from June 30 to 2022-10-30 in Sichuan Maternal and Child Health Hospital were selected as the research objects,and 70 single pregnant women who underwent emergency vaginal cervical ceration due to cervical insufficiency≤2.5cm were selected as the single control group.The differences in pregnancy and neonatal outcomes between the two groups were compared.In addition,a total of 62 pregnant women who met the criteria were randomly selected as the twin control group,and pregnancy outcomes and neonatal outcomes of pregnant women in the twin ring ligation group and the twin control group were compared.And the other based on weighted(PSW)propensityscoreweighting,propensity score of general linear model and binary logistic regression model further evaluation group differences between the pregnancy outcome and neonatal outcome.Results:1.A total of 70 eligible patients in the single ligation group and 34 in the twin ligation group were included.Compared with the single ligation group,the pregnant women in the twin ligation group had a higher proportion of pregnancies by assisted reproductive technology(64.7% vs 17.1%)and a larger gestational age(165.88±18.88 days vs 149.41±28.84 days).There were statistically significant differences between the two groups in prolongation of pregnancy(days),premature delivery,full-term delivery,delivery mode and chorioamnitis(P < 0.05).In the twin ring ligation group,the prolongation of pregnancy was shorter,the full-term delivery rate was lower,the preterm delivery rate was higher,the incidence of chorioamnitis was higher,and the delivery mode was cesarean section.However,there was no significant difference in labor time,abortion rate,incidence of premature rupture of membranes,cervical laceration and placental abruption between the two groups(P > 0.005).2.Compared with the single ligation group,there were statistically significant differences in the rate of neonatal transfer,birth weight and body length between the two groups(P < 0.05).In the twin ligation group,the rate of neonatal transfer,lower birth weight and shorter body length were higher.There were no significant differences in APgar1-5-10 scores,retinopathy of prematurity,necrotizing enterocolitis,neonatal asphyxia,and 28-day survival of neonates between the two groups(P > 0.05),indicating that the outcomes of neonates in the two groups were similar.3.After controlling confounding factors,weighted evaluation analysis based on propensity score was performed in the twin and single ligation groups.(1)The probability of full-term delivery OR=0.245 in the twin ligation group was lower than that in the single ligation group,P<0.001;(2)Preterm birth OR=4.192 in the twin group was higher than that in the single group,P<0.001;(3)There was no significant difference in premature rupture of membranes(OR=1.172)between the two groups(P=0.583).(4)chorioamnitis OR=1.984 in the twin ring-tying group was higher than that in the single ring-tying group,P=0.016;(5)The birth weight of newborns participating in treatment B=-707.950,P<0.001,the average birth weight of newborns in the twin ligation group was 707.950 g lower than that in the single ligation group;(6)The 28-day survival rate of newborns in the twin ring ligation group was 0.928,and the 28-day survival rate of newborns in the twin ring ligation group was lower than that in the single ring ligation group,P<0.001.4.A total of 34 pregnant women in the twin ring tying group and 62 pregnant women in the twin control group met the inclusion and exclusion criteria.Compared with the twin control group,the method of conception in the twin ring tying group was less(23.5%VS53.2%),and the prevalence rate of polycystic ovarian syndrome was higher(26.5%3.2%).There were statistically significant differences in term delivery rate,abortion rate,chorioamnitis,neonatal transfer rate,birth weight,body length and APgar1-5-10 between the two groups(P < 0.05).The twin-fetus ligation group had lower term delivery rate,higher abortion rate and higher chorioamnitis prevalence rate.The rate of neonatal transfer,lower birth weight,shorter body length,and lower APgar1-5-10 scores were all higher in the twin ring-tied group.There were no statistical differences in the rate of premature rupture of membranes,cervical laceration,premature delivery,placental abruption,neonatal necrotizing enterocolitis,retinopathy of prematurity between the two groups(P > 0.05).5.After controlling confounding factors,weighted evaluation analysis based on propensity score was performed in the twin ring tying group and the twin control group.(1)The probability of full-term birth OR=4.822 in the control group was higher than that in the twin ring tying group(P=0.008).(2)The preterm birth OR=0.457 in the control group was lower than that in the twin-tied group(P=0.008).(3)The birth weight of newborns participating in the treatment: B=451.100,P=0.023.The average birth weight of newborns in the twin control group was 451.100 g higher than that in the twin ligation group.Conclusion:1.Both twin pregnancy and single pregnancy pregnant women with cervical insufficiency can prolong the pregnancy time after vaginal emergency cervical lacing.Single pregnancy women with cervical lacing can prolong the gestational week longer than twin pregnancy women with cervical lacing,but the delivery time of the two is similar.2.The outcomes of twins pregnant women with cervical dysfunction and singlet pregnant women who delivered after emergency cervical cervicectomy were similar.3.Among the pregnant women who underwent cervix ligation surgery,the proportion of conception by assisted reproductive technology was significantly higher than that of the twin control group(64.7% vs 45.2%),which was significantly higher than that of the single group.Moreover,twin pregnancy is a high risk factor for cervical insufficiency,and the incidence of twin pregnancy is high among the pregnant women conceived by assisted reproductive technology.It suggests whether multiple pregnancies should be avoided as far as possible during assisted reproduction and surgery,so as to reduce the occurrence of adverse pregnancy outcomes such as cervical insufficiency,premature birth and abortion. |
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