Diagnosis and treatment of cervical incompetence combined with intrauterine adhesions

Role of body mass index in pregnancy outcomes after emergency cerclage for cervical insufficiency in singleton pregnant patients

BACKGROUND

The study aims were to analyze pregnancy outcomes after the use of emergency cerclage in patients with different BMIs.

METHODS

A total of 76 singleton pregnant patients who underwent emergency cerclage at a tertiary comprehensive hospital in China between Jan 2017 and Dec 2021 were retrospectively divided into an obesity group of 37 patients with BMIs ≥ 28 kg/m2 and a non-obesity group of 39 patients with BMIs < 28 kg/m2. The medical records of patients were reviewed and all relevant clinical data were further collected into an itemized data spreadsheet for various analyses.

RESULTS

Emergent cerclage, along with amnioreduction if needed, could be safely performed on both obese and non-obese pregnant women with a dilated external cervix (> 1 cm), which effectively prolonged the gestational week up to ≥ 25 weeks. Obese gravidae had shorter suture-to-delivery intervals and mean pregnancy lengths but more spontaneous preterm births before 37 weeks, and a lower live birth rate (P < 0.05). Logistic regression analysis revealed that BMI, how many times cerclages have been performed during pregnancy (frequency of cerclage) and bacterial vaginosis, aerobic vaginitis and vulvovaginal candidiasis (vaginal microecology) were significantly correlated with fetal loss (P < 0.05), while rank correlation analysis established a negative correlation between BMI values and the suture-to-delivery interval (P = 0.031).

CONCLUSIONS

Pregnant cervical insufficiency patients with BMIs > 28 kg/m2 may ill-serve the gestational outcomes and suture-to-delivery interval after their emergent cerclage. Additionally, BMI, frequency of cerclage and vaginal microecology accounted for higher fetal loss in patients who underwent emergency cerclage.

Effectiveness and perinatal outcomes of history-indicated, ultrasound-indicated and physical examination-indicated cerclage: a retrospective study

OBJECTIVE

To evaluate the effectiveness and perinatal outcomes of cerclage procedure according to indication.

METHODS

The pregnancy and neonatal outcomes of the patients who underwent cerclage with the diagnosis of cervical insufficiency between January 2016 and December 2020 were retrospectively analyzed. Patients were categorized into three groups: a history-indicated group, an ultrasound-indicated group and a physical examination-indicated group.

RESULTS

Seventy-three patients who underwent cerclage were included in the study. Of these, 41 (56.2%) had history-indicated, 17 (23.3%) had ultrasound-indicated and 15 (20.5%) had physical examination-indicated cerclages. Compared to history- and ultrasound-indicated cerclage group, duration from cerclage to delivery (18.6 ± 6.9 weeks vs 17.8±5.9 weeks vs 11 ± 5.3 weeks, p = 0.003) was significantly lower and delivery < 28 weeks (9.8% vs 5.9% vs 33.3%, p = 0.042) and delivery < 34 weeks of gestation (26.8% vs 11.8% vs 60%, p = 0.009) were significantly higher in physical examination-indicated cerclage group. In physical examination-indicated cerclage, compared with history- and ultrasound-indicated cerclage low birth weight, low APGAR score, neonatal intensive care unit admission and neonatal mortality were higher, although not statistically significant (p > 0.05).

CONCLUSION

Pregnant women who underwent physical examination-indicated cerclage had higher risks for preterm delivery < 28 weeks and < 34 weeks than history- and ultrasound-indicated cerclage.

Efficacy of hysteroscopic cold knife separation on intrauterine adhesions

OBJECTIVE

This research aimed to explore the efficacy of hysteroscopic cold knife separation in the treatment of intrauterine adhesions (IUA).

METHODS

Altogether 110 patients with IUA who were treated in our hospital were randomized into the observation group (n=55, hysteroscopic cold knife) and the control group (n=55, hysteroscopic electroacupuncture and collecting ring). This research compared the operation-related indexes (operation time, intraoperative blood loss, amount of distending media), IUA and menstrual flow, endometrial epithelization of the uterine wound, endometrial thickness one month after operation, recurrence and pregnancy rates one year after operation.

RESULTS

The operation time and intraoperative blood loss in the observation group were less than those in the control group (all P<0.05). After treatment, the total effective rate of IUA, menstrual flow and satisfaction rate of endometrial epithelization of the uterine wound in the observation group were higher than those in the control group, and the recurrence rate of the former one year after operation was lower (all P<0.05). One month after operation, the thickness of the endometrium in the observation group was clearly larger than that in the control group on the 11th and 13th day of menstruation (all P<0.05).

CONCLUSION

Hysteroscopic cold knife separation can improve the efficacy of IUA and protect the endometrium.