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Background <p>This study aimed to assess whether perioperative atosiban improves pregnancy outcomes in women with fetal membrane exposure undergoing physical examination-indicated cerclage by prolonging gestational latency and reducing preterm birth risk.</p> Methods <p>This retrospective cohort study was conducted at Chongqing Maternal and Child Health Hospital, including singleton pregnancies that underwent physical examination-indicated transvaginal cerclage between January 2018 and June 2024. Patients with cervical dilation and fetal membrane exposure (16 0/7–25 0/7&#xa0;weeks) were included. Cerclage was performed using the McDonald technique under spinal anesthesia. Participants were categorized according to the administration of perioperative atosiban. The primary outcome was pregnancy latency of at least 28&#xa0;days after cerclage placement. Secondary outcomes included preterm birth rates, neonatal outcomes, and complications. Bivariable analyses were performed for group comparisons. Multivariable logistic regression models were used to estimate adjusted odds ratios for binary outcomes, while linear regression was applied to continuous outcomes. Gestational latency was evaluated using Kaplan–Meier analysis. To reduce confounding, propensity score matching was conducted.</p> Results <p>A total of 101 women with singleton pregnancies who underwent cerclage placement were included, with 54 (53.5%) receiving perioperative atosiban. Women exposed to atosiban had a significantly higher frequency of cervical dilation ≥ 2&#xa0;cm prior to cerclage (31.5% vs. 10.6%, <i>P</i> = 0.022) and a higher gestational age at cerclage placement (24.0 ± 0.9&#xa0;weeks vs. 23.1 ± 1.5&#xa0;weeks, <i>P</i> = 0.004). In unadjusted analyses, atosiban use was associated with a higher likelihood of achieving ≥ 28&#xa0;days of pregnancy latency (85.2% vs. 61.7%, <i>P</i> = 0.009) and a higher gestational age at delivery (35.7 ± 4.1 vs. 31.7 ± 6.7&#xa0;weeks, <i>P</i> &lt; 0.001). Atosiban also reduced preterm birth rates at various thresholds and improved neonatal outcomes, including birth weight (2610.0 ± 866.0&#xa0;g vs. 1938.0 ± 1299.0&#xa0;g, <i>P</i> = 0.003) and survival (94.4% vs. 68.1%, <i>P</i> = 0.002). After adjusting for potential confounders, the associations for latency ≥ 28&#xa0;days, gestational age at delivery, preterm birth, birth weight, neonatal survival, and low Apgar scores remained statistically significant (all <i>P</i> &lt; 0.05). Pregnancy latency showed a non-significant trend toward prolongation after adjustment.</p> Conclusions <p>Perioperative atosiban administered during physical examination-indicated cerclage was associated with a reduced risk of extreme preterm birth (&lt; 28&#xa0;weeks) and improved neonatal survival. However, it was not associated with achieving term gestation (≥ 37&#xa0;weeks), suggesting a potential role in short-term pregnancy stabilization rather than sustained prolongation.</p>

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Perioperative atosiban use in physical examination-indicated cerclages with fetal membrane exposure to improve gestational latency in singleton pregnancies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Qin Li,
  • Han Xiang,
  • Cuihua Zhang,
  • Xueyan Wang,
  • Deying He,
  • Hongbo Qi,
  • Xiaofeng Yang

摘要

Background

This study aimed to assess whether perioperative atosiban improves pregnancy outcomes in women with fetal membrane exposure undergoing physical examination-indicated cerclage by prolonging gestational latency and reducing preterm birth risk.

Methods

This retrospective cohort study was conducted at Chongqing Maternal and Child Health Hospital, including singleton pregnancies that underwent physical examination-indicated transvaginal cerclage between January 2018 and June 2024. Patients with cervical dilation and fetal membrane exposure (16 0/7–25 0/7 weeks) were included. Cerclage was performed using the McDonald technique under spinal anesthesia. Participants were categorized according to the administration of perioperative atosiban. The primary outcome was pregnancy latency of at least 28 days after cerclage placement. Secondary outcomes included preterm birth rates, neonatal outcomes, and complications. Bivariable analyses were performed for group comparisons. Multivariable logistic regression models were used to estimate adjusted odds ratios for binary outcomes, while linear regression was applied to continuous outcomes. Gestational latency was evaluated using Kaplan–Meier analysis. To reduce confounding, propensity score matching was conducted.

Results

A total of 101 women with singleton pregnancies who underwent cerclage placement were included, with 54 (53.5%) receiving perioperative atosiban. Women exposed to atosiban had a significantly higher frequency of cervical dilation ≥ 2 cm prior to cerclage (31.5% vs. 10.6%, P = 0.022) and a higher gestational age at cerclage placement (24.0 ± 0.9 weeks vs. 23.1 ± 1.5 weeks, P = 0.004). In unadjusted analyses, atosiban use was associated with a higher likelihood of achieving ≥ 28 days of pregnancy latency (85.2% vs. 61.7%, P = 0.009) and a higher gestational age at delivery (35.7 ± 4.1 vs. 31.7 ± 6.7 weeks, P < 0.001). Atosiban also reduced preterm birth rates at various thresholds and improved neonatal outcomes, including birth weight (2610.0 ± 866.0 g vs. 1938.0 ± 1299.0 g, P = 0.003) and survival (94.4% vs. 68.1%, P = 0.002). After adjusting for potential confounders, the associations for latency ≥ 28 days, gestational age at delivery, preterm birth, birth weight, neonatal survival, and low Apgar scores remained statistically significant (all P < 0.05). Pregnancy latency showed a non-significant trend toward prolongation after adjustment.

Conclusions

Perioperative atosiban administered during physical examination-indicated cerclage was associated with a reduced risk of extreme preterm birth (< 28 weeks) and improved neonatal survival. However, it was not associated with achieving term gestation (≥ 37 weeks), suggesting a potential role in short-term pregnancy stabilization rather than sustained prolongation.