Indikationsbezogene Effektivität von Verschlussoperationen am Muttermund

Zusammenfassung

Ziel dieser Studie ist es herauszufinden, welche Operationsmethode [Totaler Muttermundverschluss (TMV), Cerclage (C) oder Kombination aus beidem (C+TMV)] bei welcher Indikation (Risikoanamnese, Zervixinsuffizienz, prolabierende Fruchtblase) die größte Tragzeitverlängerung erbringt. Hierzu wurden 200 am Hause durchgeführte Eingriffe ausgewertet. Bei Patientinnen mit Risikoanamnese (Z. n. Spätabort/Frühgeburt, n=80) konnte durch einen prophylaktischen TMV die Rate an Lebendgeburten von 35% ohne TMV auf 95% mit TMV erhöht werden (p<0,001). Die Risikodifferenz für einen Spätabort betrug − 60% (p<0,001) und für eine Frühgeburt − 30% (p=0,01) nach TMV. Bei dieser Indikation scheint der TMV der Cerclage hinsichtlich der Tragzeitverlängerung überlegen (139 vs. 113 Tage), die kombinierte Operationsmethode (Cerclage+TMV) hingegen nur wenig Vorteil zu bringen (142 Tage). Bei Patientinnen mit Zervixinsuffizienz (n=86) konnte die Schwangerschaft im Mittel um 82 (C), 79 (TMV) und 109 Tage (C+TMV) (p=0,003–0,017) verlängert und bei Patientinnen mit prolabierender Fruchtblase (n=34) im Mittel um 63 (C), 61 (TMV) und 76 (C+TMV) Tage verlängert werden. Nach vorliegenden Daten kann bei Patientinnen mit Zervixinsuffizienz bzw. prolabierender Fruchtblase durch eine Kombination aus Cerclage und TMV die größte Tragzeitverlängerung erzielt werden. Diese Datenanalyse soll als Basis einer prospektiv randomisierten Studie zur gleichen Thematik dienen.

Abstract

The aim of this study was to identify which operation technique [total cervical occlusion (TMV), cerclage (C) or combination of both (TMV+C)] would lead to the greatest pregnancy prolongation in 3 different collectives of patients at risk (history of preterm birth, cervical insufficiency, prolapsing membranes). In this retrospective data collection, 200 cervical occlusions performed between 1997 and 2010 were analysed. In patients with a history of preterm birth/stillbirth (n=80) a prophylactic TMV increased the lifebirth rate from 35% without TMV to 95% with TMV (p<0.001). The risk diminuation after TMV was − 60% for stillbirth (p<0.001) and − 30% for preterm birth (p=0.01). In this subcollective the TMV seemed to be more effective in pregnancy prolongation (days) than C (139 vs. 113 days), however the combination of both (C+TMV) did not add much benefit (142 days). In patients with cervical insuffiency (n=86) the pregnancy could be prolonged by 82 (C), 79 (TMV) und 109 days (C+TMV) (p=0.003–0.017) and in patients with membrane prolaps (n=34) by 63 (C), 61 (TMV) und 76 (C+TMV) days. According to present data, the combination of cerclage and TMV has the highest benefit on pregnancy prolongation. This analysis should provide a basis for randomised controlled studies on this topic.

Schlüsselwörter

Frühgeburt - Cerclage - Totaler Muttermundverschluss (TMV) - Spätabort

Key words

preterm birth - cerclage - total cervical occlusion - stillbirth

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