Effects of vaginal microbiota and cervical cerclage on obstetric outcomes of twin pregnancies with cervical incompetence: a retrospective study

Zhou, Xuan; Li, Xiao-Xue; Ge, Yimeng; Lai, Shaoyang; Zhou, Luo-Qi; Li, Feng; Zhao, Jie

doi:10.1007/s00404-021-06119-2

Cited by 7 publications

(3 citation statements)

References 33 publications

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“…Twin pregnancy has a 50% rate of preterm birth [30] and a 12-fold increased risk of premature birth compared with singleton pregnancy [31] , partly due to cervical incompetence [32] . The incidence of cervical incompetence in multiple pregnancies is 5%, which is signi cantly higher than that of 0.05%~1.8% in singleton pregnancies [33] . Currently, whether cervical cerclage should be performed in women who are pregnant with twins or multiples with cervical insu ciency has been controversial.…”

Section: Discussionmentioning

confidence: 79%

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: A retrospective study from a single centre

Huang,

Wang,

Wang

et al. 2023

Preprint

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Objective: The objective was to investigate and compare the pregnancy and neonatal outcomes of patients who underwent ultrasound- and physical examination-indicatedcervical cerclage and to explore the influencing factors of preterm delivery before 34 weeks. Methods:The sociodemographic characteristics and clinical data of patients with a diagnosis of cervical incompetence who underwent ultrasound- and physical examination-indicated transvaginal cervical cerclage at Nanjing Maternal and Child Health Hospital from January 2020 to December 2022 were retrospectively analyzed. The pregnancy and neonatal outcomes of the patients were evaluated. Results: This study included 141 participants who underwent cervical cerclage, including 71 with ultrasound-indicated cerclage and 70 with physical examination-indicated cerclage. Compared to the ultrasound-indicated cerclage group, in the physical examination-indicated cerclage group, the duration from cerclage to delivery, birth weight, and APGAR score were significantly lower, and the rates of delivery at <28 weeks, <32 weeks, <34 weeks, and <37 weeks of gestation and neonatal mortality were significantly higher (all P<0.05). Compared to the physical ultrasound-indicated cerclage group, in the physical examination-indicated cerclage group, maternal blood inflammatory markers, such as C-reactive protein, the systemic immune-inflammation index and the systemic inflammation response index were significantly higher (P <0.05). Additionally, maternal blood inflammatory markers, such as the C-reactive protein level, white blood cell count, platelet to lymphocyte ratio, the systemic immune-inflammation index, and the systemic inflammation response index were significantly higher in the group with delivery before 34 weeks of gestation. Furthermore, the results demonstrated that twin pregnancy had the highest OR for preterm delivery before 34 weeks of gestation (OR=3.829; 95% CI 1.413-10.373; P=0.008), as well as the following: the SII level (OR = 1.001; 95% CI 1.000-1.002; P=0.003) and C-reactive protein level (OR =1.083; 95% CI 1.038-1.131; P=0.022). The risk factors for preterm delivery before 34 weeks of gestation are twin gestation, an increased SII level and an increased C-reactive protein level, which have good combined predictive value. Conclusion: In patients with cervical insufficiency, ultrasound-indicated cervical cerclage appears to lead to better pregnancy outcomes than physical examination-indicated cerclage. Twin pregnancy and maternal blood inflammatory markers, such as the CRP level and the SII, are associated with premature delivery before 34 weeks of gestation.

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Section: Discussionmentioning

confidence: 79%

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: A retrospective study from a single centre

Huang,

Wang,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Twin pregnancy has a 50% rate of preterm birth [ 33 ] and a 12 - fold increased risk of preterm birth compared with singleton pregnancy [ 34 ], partly due to cervical incompetence [ 35 ]. The incidence of CIC in multiple pregnancy is 5%, which is significantly higher than that in singleton pregnancies, ranging from 0.05% ~ 1.8% [ 36 ]. Currently, whether CC should be performed in women with cervical insufficiency who are pregnant with twins or multiples is controversial.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: a retrospective study from a single centre

Huang,

Wang,

Wang

et al. 2024

BMC Pregnancy Childbirth

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Objective Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality worldwide, and cervical incompetence (CIC) is a significant contribution. Cervical cerclage (CC) is an effective obstetric intervention. However, many clinical factors affect the success rate of surgery. The objective was to investigate and compare the pregnancy and neonatal outcomes of patients who underwent ultrasound- and physical examination-indicated cervical cerclage and to explore the influencing factors of preterm delivery before 34 weeks. Methods The sociodemographic characteristics and clinical data of patients with a diagnosis of cervical incompetence who underwent ultrasound- and physical examination-indicated transvaginal cervical cerclage at Nanjing Maternal and Child Health Hospital from January 2020 to December 2022 were retrospectively analyzed. The pregnancy and neonatal outcomes of the patients were evaluated. Continuous variables were compared using Student’s t test (for normally distributed data) or the Mann-Whitney U test (for nonnormally distributed data). Categorical variables were analysed using the chi-square test or Fisher’s exact test. Additionally, logistic regression analyses and receiver operating characteristic curves were used to evaluate the associations of inflammatory markers with maternal and neonatal outcomes. Results This study included 141 participants who underwent cervical cerclage, including 71 with ultrasound-indicated cerclage and 70 with physical examination-indicated cerclage. Compared to those in the ultrasound-indicated cerclage group, the duration from cerclage to delivery, birth weight, and APGAR score in the physical examination-indicated cerclage group were significantly lower, and the rates of delivery at < 28 weeks, < 32 weeks, < 34 weeks, and < 37 weeks of gestation and neonatal mortality were significantly higher (all P < 0.05). Compared to those in the physical ultrasound-indicated cerclage group, in the physical examination-indicated cerclage group, maternal blood inflammatory markers, such as C-reactive protein (CRP), the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) were significantly higher (P < 0.05). Additionally, maternal blood inflammatory markers, such as the CRP, white blood cell count, platelet to lymphocyte ratio (PLR), SII, and SIRI were significantly higher in the group with delivery before 34 weeks of gestation. Furthermore, the results demonstrated that twin pregnancy had the highest OR for preterm delivery before 34 weeks of gestation (OR = 3.829; 95% CI 1.413–10.373; P = 0.008), as well as the following: the SII level (OR = 1.001; 95% CI 1.000-1.002; P = 0.003) and CRP level (OR = 1.083; 95% CI 1.038–1.131; P = 0.022). The risk factors for preterm delivery before 34 weeks of gestation were twin gestation, an increased SII level and an increased CRP level, which had good combined predictive value. Conclusion In patients with cervical insufficiency, ultrasound-indicated cervical cerclage appears to lead to better pregnancy outcomes than physical examination-indicated cerclage. Twin pregnancy and maternal blood inflammatory markers, such as the CRP level and the SII, are associated with preterm delivery before 34 weeks of gestation.

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“…Zhou et al conducted a study that showed that, compared to the pre-cerclage vaginal microbiota, the post-cerclage vaginal microbiota exhibited greater richness, increased abundance of Lactobacillus , and decreased abundance of Gardnerella [ 29 ]. Improvements in the vaginal environment and pregnancy outcomes were also observed after cervical cerclage.…”

Section: Discussionmentioning

confidence: 99%

Nomogram-based risk assessment for emergency cervical cerclage failure in patients with cervical insufficiency

Chen,

Guo,

Fan

et al. 2024

Heliyon

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Effects of vaginal microbiota and cervical cerclage on obstetric outcomes of twin pregnancies with cervical incompetence: a retrospective study

Cited by 7 publications

References 33 publications

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: A retrospective study from a single centre

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: A retrospective study from a single centre

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: a retrospective study from a single centre

Nomogram-based risk assessment for emergency cervical cerclage failure in patients with cervical insufficiency

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