【摘要】 目的:探讨改良式宫颈环扎术对自然受孕及体外受精-胚胎移植技术(IVF-ET)受孕的单胎宫颈机能不全患者妊娠结局的影响。方法:回顾分析2014年4月至2020年12月在山东大学齐鲁医院(青岛)医院行改良式宫颈环扎术并有分娩结局的271例宫颈机能不全单胎妊娠孕妇的临床资料，其中自然受孕228例(自然妊娠组),IVF-ET术后患者43例(IVF-ET组)。将两组再分为预防性宫颈环扎术、应急性宫颈环扎术、紧急宫颈环扎术。分析两组的妊娠结局、妊娠期合并症及并发症的差异。结果:自然妊娠组的经阴分娩率(56.34%)高于IVF-ET组(23.81%)(P<0.01)。自然妊娠组中，预防性宫颈环扎术组的手术孕周、早产率、流产率较应急性宫颈环扎术组、紧急宫颈环扎组小，延长孕周、新生儿体重、足月产率较应急性宫颈环扎术组、紧急宫颈环扎组高。应急性宫颈环扎术组延长孕周、新生儿出生体重高于紧急宫颈环扎组(P<0.05)。自然妊娠组中，预防性宫颈环扎术组、应急性宫颈环扎术组的分娩孕周大于紧急宫颈环扎组(P<0.05)。IVF-ET组中，预防性宫颈环扎术组的手术孕周、早产率、流产率小于应急性宫颈环扎术组、紧急宫颈环扎组，分娩孕周、延长孕周、新生儿体重、足月产率大于应急性宫颈环扎术、紧急宫颈环扎组(P<0.05);应急性宫颈环扎术组的早产率高于紧急宫颈环扎组，流产率低于紧急宫颈环扎组(P<0.05)。应急性宫颈环扎术组中，IVF-ET组延长孕周较自然妊娠组长，手术孕周、分娩孕周、新生儿体重、足月产率小于自然妊娠组(P<0.05)。IVF-ET组的妊娠期高血压疾病发生率(34.88%)高于自然妊娠组(8.77%)(P<0.001),前置胎盘发生率(11.63%)高于自然妊娠组(3.50%)(P=0.022)。结论:改良式宫颈环扎术能有效地延长不同受孕方式宫颈机能不全患者的妊娠孕周，改善妊娠结局。预防性宫颈环扎术改善妊娠结局效果最佳。更多还原

【Abstract】 Objective:To investigate the effect of modified cervical cerclage on pregnancy outcome in single pregnancy with cervical insufficiency via natural conception or IVF-ET.Methods:The clinical datas of 271 singleton pregnant women who underwent modified cervical cerclage in Qilu Hospital(Qingdao) from April 2014 to December 2020 with delivery outcome were retrospectively analyzed.The 228 cases were naturally conceived(natural conception group) and 43 cases were after IVF-ET(IVF-ET group).The two groups were subdivided into elective cervical cerclage, urgent cervical cerclage and emergency cervical cerclage.The differences of pregnancy outcomes, complications and complications were analyzed between the two groups.Results:The rate of vaginal delivery in the natural conception group(56.34%) was higher than that in the IVF-ET group(23.81%)(P<0.01).In the natural conception group, the operative gestational age, preterm birth rate and abortion rate of elective cervical cerclage were smaller than those of urgent cervical cerclage and emergency cervical cerclage, while the extended gestational age, newborn weight and full term birth rate were higher than those of urgent cervical cerclage and emergency cervical cerclage.The extended gestational age and newborn weight in urgent cervical cerclage were longer than those in emergency cervical cerclage(P<0.05).In the natural pregnancy group, the delivery gestational age of elective cervical cerclage and urgent cervical cerclage group was longer than that of emergency cervical cerclage group(P<0.05).In the IVF-ET group, the operative gestational age, preterm birth rate and abortion rate of elective cervical cerclage were lower than those of urgent cervical cerclage and emergency cervical cerclage group, and the delivery gestational age, extended gestational age, newborn weight and term birth rate were higher than those of urgent cervical cerclage and emergency cervical cerclage group(P<0.05).The rate of premature delivery was higher in the urgent cervical cerclage group than that in the emergency cervical cerclage group, and the rate of abortion was lower than that in the emergency cervical cerclage group(P<0.05).In the urgent cervical cerclage group, the extended gestational age in the IVF-ET group was longer than that in the natural pregnancy group(P<0.05).The operative gestational age, delivery gestational age, newborn weight and full term birth rate in the IVF-ET group was shorter than that in the natural pregnancy group(P<0.05).The incidence of hypertension in pregnancy in the IVF-ET group(34.88%) was higher than that in the natural conception group(8.77%)(P<0.001),and the incidence of placenta previa(11.63%) was higher than that in the natural conception group(3.50%)(P=0.022).Conclusion:Modified cervical cerclage can effectively prolong the gestational age and improve the pregnancy outcome of patients with cervical dysfunction by different conception methods.Elective cervical cerclage has the best effect on improving pregnancy outcome.更多还原