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在单子妊娠中没有先前的自发早产减少早产:使用个人患者级数据进行随机对照试验的元分析

Vincenzo Berghella¹, Siani Harding¹, Kypros Nicolaides²

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.

American journal of obstetrics & gynecology MFM

|August 19, 2025

概括

宫围显著减少了24周前宫长度短 (≤20.9mm) 的无症状单子妊娠的早产. 然而,它没有显示出对子宫长度高达25mm的整体益处.

科学领域:

孕产妇和胎儿的医学
产科产科产科产科产科
周围生理学周围生理学

背景情况:

过早分娩 (PTB) 仍然是新生儿发病率和死亡率的主要原因.
对子宫长度 (CL) 的超声波评估对于识别患有PTB风险的怀孕至关重要.
宫围是一种加强宫的程序,但其在特定无症状人群中的有效性需要进一步评估.

研究的目的:

评估宫围在预防PTB方面的有效性.
为了评估 cerclage 对怀孕的影响,在怀孕中期,经阴道超声波宫长度 (TVU CL) 很短,没有自发PTB的病史.

主要方法:

我们对MEDLINE,ClinicalTrials.gov和Cochrane中央注册表进行了系统的搜索.
包括无症状单项怀孕的随机对照试验 (RCT) 与TVU CL ≤25.9mm,随机分为 cerclage 或没有 cerclage.
来自6个RCT (507名参与者) 的个体患者数据被合并用于元分析.

主要成果:

总体而言,结剂没有显著减少PTB<37周 (RR 0.88,95% CI 0.59-1.31).
在一个子组分析中,cerclage显著降低了PTB<37周 (RR0.75,95%CI0.56-0.99) 在CL ≤20.9mm24周之前.
在这个小组中,围与更长的延迟时间相关 (p=0.049).

结论:

宫围与PTB<37周的显著减少以及24周前TVUCL ≤20.9mm的无症状单胎妊娠的更长潜伏期有关.
在这个人群中,Cerclage没有显示出对预防TVU CL ≤25mm的PTB的总体显著影响.
这些发现凸显了CL值和妊娠年龄在确定 cerclage 的益处方面的重要性.

关键词:

宫的长度宫的长度过早出生过早出生通过阴道的超声波.超声波显示的围.

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