Servikal yetmezliği olan ve membranları prolabe olan/olmayan gebelerde acil servikal serklajın perinatal sonuçlarının karşılaştırılması

Abstract

Amaç: Fizik muayene endikasyonu ile acil servikal serklaj (ECC) uygulanan tekil gebeliklerde, fetal membranların prolabe olup olmamasına göre perinatal sonuçların değerlendirilmesi ve karşılaştırılması amaçlanmıştır. Yöntemler: Bu retrospektif kohort çalışmada, Ocak 2020 ile Ocak 2025 tarihleri arasında servikal yetmezlik nedeniyle fizik muayene endikasyonu ile ECC uygulanan toplam 80 tekil gebelik incelendi. Hastalar, spekulum muayenesinde fetal membranların prolabe olup olmamasına göre iki gruba ayrıldı: prolabe grup (n=35) ve non-prolabe grup (n=45). Gruplar arasında demografik, obstetrik, laboratuvar ve neonatal sonuçlar karşılaştırıldı. İstatistiksel analizlerde uygun parametrik veya parametrik olmayan testler kullanıldı. NICU yatışını öngören bağımsız faktörleri belirlemek amacıyla çok değişkenli lojistik regresyon analizi yapıldı. Bulgular: Prolabe grupta gravida sayısı, lökosit, nötrofil ve CRP düzeyleri anlamlı şekilde daha yüksekti (p<0.05). Doğum haftası (medyan 26+5 vs. 33+2 hafta), latency süresi (medyan 34 vs. 92 gün) ve doğum ağırlığı (ortalama 1752 g vs. 2635 g) prolabe grupta anlamlı şekilde daha düşüktü (tümü p<0.001). NICU yatışı (%68.6 vs. %35.6), mekanik ventilasyon ihtiyacı (%28.6 vs. %6.7) ve 5. dakika Apgar skorunun düşüklüğü gibi parametreler de prolabe grupta belirgin şekilde yüksekti (p<0.01). Çok değişkenli analizde prolabe membran varlığı (OR >2), yüksek CRP düzeyi ve 5. dakika Apgar <7, NICU yatışı için bağımsız öngörücüler olarak belirlendi. Sonuç: Fetal membran prolapsusu olan ECC olgularında, doğum haftası ve doğum ağırlığı daha düşük, latency süresi daha kısa ve neonatal morbidite ile NICU yatışı daha yüksektir. Bu bulgular, ileri düzey servikal yetmezlik ve prolabe membran varlığında ECC’nin etkinliğinin sınırlı kalabileceğini ve tedavi stratejisinin bireyselleştirilmesi gerektiğini göstermektedir.

Keywords

• Servikal Serklaj
• Servikal Yetmezlik
• Preterm Doğum
• Fetal Membran Prolapsusu
• Yenidoğan Yoğun Bakım

Comparison of perinatal outcomes following emergency cervical cerclage with and without prolapsed fetal membranes

Abstract

Aims: This study aimed to compare the perinatal outcomes of singleton pregnancies undergoing emergency cervical cerclage (ECC) indicated by physical examination, based on the presence or absence of prolapsed fetal membranes. Methods: In this retrospective cohort study, a total of 80 singleton pregnancies that underwent ECC due to cervical insufficiency between April 2023 and April 2025 were analyzed. Patients were divided into two groups according to whether prolapsed fetal membranes were observed during speculum examination: the prolapsed group (n=35) and the non-prolapsed group (n=45). Maternal demographic characteristics, laboratory parameters, as well as obstetric and neonatal outcomes, were compared between the groups. Appropriate parametric or non-parametric tests were used for statistical analyses. A binary logistic regression analysis was performed to identify independent predictors of NICU admission. Results: The two groups were comparable regarding maternal age, body-mass index (BMI), and parity (p>0.05). Inflammatory parameters showed significant differences: the prolapsed group had higher white blood cell and neutrophil counts, as well as elevated CRP levels (all p<0.05). Regarding cerclage-related findings, baseline cervical dilation and effacement were greater in the prolapsed group, and cervical length after cerclage was significantly shorter. In addition, the latency period was shorter in the prolapsed group (median 34 vs. 92 days, p<0.001). Neonatal outcomes also differed substantially: gestational age at delivery (median 26+5 vs. 33+2 weeks) and birthweight (mean 1752 g vs. 2635 g) were lower in the prolapsed group, while NICU admission (68.6% vs. 35.6%), need for mechanical ventilation (28.6% vs. 6.7%), and low 5-minute Apgar scores were significantly higher (all p<0.01). In binary logistic regression analysis, the presence of prolapsed membranes, elevated CRP levels, and low 5-minute Apgar score were identified as independent predictors of NICU admission. Conclusion: In ECC cases with prolapsed fetal membranes, gestational age and birth weight are lower, latency period is shorter, and neonatal morbidity and NICU admission are higher. These findings suggest that the effectiveness of ECC may be limited in cases of advanced cervical insufficiency with membrane prolapse, and that treatment strategies should be individualized accordingly.

Keywords

• Cervical cerclage
• cervical insufficiency
• preterm birth
• fetal membrane prolapse
• neonatal intensive care

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