宫颈环扎术治疗宫颈机能不全的临床研究

[目的]探讨宫颈环扎术治疗宫颈机能不全的疗效.[方法]收集2008年11月至2012年11月宫颈机能不全者52例,30例行宫颈环扎术(环扎组),22例拒绝手术(非环扎组)仅予卧床等保胎治疗.比较两组妊娠结局等各项指标.[结果]环扎组与非环扎组除早产率外,足月妊娠率,流产率及新生儿成活率比较差异均有统计学意义(P＜0.05);环扎组中20例在妊娠14～16周、10例在妊娠17～28周行宫颈环扎术,两个时间段孕妇流产、早产、足月产率比较差异均有统计学意义(P＜0.05).[结论]宫颈机能不全行宫颈环扎术可延长孕妇的孕周,提高胎儿的成活率;对有宫颈机能不全者,在妊娠14～16周择期行宫颈环扎术较佳.     

宫颈环扎术治疗宫颈机能不全妊娠结局

目的探讨宫颈环扎术治疗宫颈机能不全的不同手术时间、手术时机的临床效果及妊娠结局。方法回顾性分析2005年5月至2009年10月22例因宫颈机能不全行宫颈环扎术患者的不同手术时间、手术时机的临床效果及妊娠结局。结果①妊娠12～16周组13例与妊娠17～28周组9例行宫颈环扎术,两组流产、早产、足月产率比较,差异均有统计学意义(P0.05);②紧急宫颈环扎术组8例与择期宫颈环扎术组14例,流产、早产、足月产率比较差异均有统计学意义(P0.05)。结论对有宫颈机能不全者,应在妊娠14～16周择期行宫颈环扎术;对孕前未能诊断宫颈机能不全者,有晚期流产史或早产史的高危孕妇孕中期B超发现宫颈机能不全,行紧急宫颈环扎术,术后加强监测、防止感染亦能取得一定临床效果,降低晚期流产率及早产率。     

宫颈环扎术治疗宫颈机能不全病人的术后护理

[目的]总结宫颈机能不全病人行宫颈环扎术的术后护理措施.[方法]回顾性分析7例宫颈机能不全病人行宫颈环扎术的临床资料.[结果]本组病人1例孕27周自然流产;6例继续妊娠,1例行剖宫产术,5例阴道分娩,分娩时间为37周～41周,新生儿均存活.[结论]加强宫颈机能不全病人行宫颈环扎术的术后护理是手术成功的关键.     

宫颈环扎术治疗宫颈机能不全43例分析

目的探讨宫颈环扎术治疗妊娠期宫颈机能不全的疗效。方法对43例孕妇合并宫颈机能不全者施行宫颈环扎术治疗,观察妊娠结局。结果孕妇手术43例中,延长妊娠至足月38例,早产4例,流产1例,胎儿成活39例。结论宫颈机能不全行宫颈环扎术可以延长孕妇的孕周,提高胎儿的成活率。     

紧急宫颈环扎术治疗妊娠合并宫颈机能不全的围术期护理

[目的]探讨紧急宫颈环扎术治疗妊娠合并宫颈机能不全的护理要点。[方法]对41例妊娠合并宫颈机能不全孕妇行紧急宫颈环扎术治疗,术前做好孕妇和家属的解释工作,减轻其心理压力,术中密切配合,术后密切观察孕妇的生命体征、宫缩、阴道流血情况和监测胎儿的胎心音,加强预防感染及宫缩抑制剂用药观察,做好饮食、活动、大小便护理等健康指导。[结果]41例孕妇手术过程顺利,37例术后1周无宫缩、感染和胎膜早破等并发症出现,新生儿存活率达82.9%,平均延长孕期43.8d。[结论]做好紧急宫颈环扎术的围术期护理对提高手术成功率和减少术后并发症及延长妊娠时间、提高胎儿成活率具有重要意义。     

宫颈环扎术治疗宫颈机能不全的妊娠结局

目的:探讨择期和紧急不同宫颈环扎术对治疗宫颈机能不全及对延长孕周和预防早产的作用。方法:纳入2017年1月至2020年6月在无锡市妇幼保健院因宫颈机能不全进行治疗的70例患者,根据孕周和手术时间不同分为择期环扎组与紧急环扎组,比较2组的治疗效果及妊娠结局。结果:70例患者行宫颈环扎术的成功率为100%,早产发生率为20.85%,2组在环扎孕周、宫颈管长度、延长孕周等方面的差异均有统计学意义(均P<0.01),紧急环扎组的早产发生率较高(P<0.05)。Pearson相关分析显示延长妊娠时间和早产发生率呈明显负相关(r=-0.490,P<0.01),宫颈管长度与早产发生率呈明显负相关(r=-0.270,P<0.01),延长妊娠时间与宫颈管长度呈明显正相关(r=0.792,P<0.01)。Cox比例危险回归分析显示紧急环扎术是早产发生的独立危险因素,择期环扎组发生早产的风险显著低于紧急环扎组(HR=2.184,95%CI:1.798~2.651,P<0.05)。结论:与紧急环扎相比,择期宫颈环扎术具有更好的临床效果,预防早产的效果优于紧急环扎术,孕期筛选高危产妇后,择期进行宫颈环扎术有利于延长孕周,预防早产,值得临床推广。     

妊娠期宫颈机能不全治疗的体会

目的 观察宫颈环扎术治疗妊娠期宫颈机能不全的效果。方法 回顾性分析30例用宫颈环扎术治疗宫颈机能不全的孕妇，其中14—24孕周的24例，26～30孕周的6例。结果14—24孕周的20例足月分娩，1例早产，26—30孕周的4例早产，2例足月分娩。结论 宫颈环扎术治疗妊娠期宫颈机能不全效果可靠，手术最佳时机为14—24周。     

用药护理干预对盐酸利托君联合紧急宫颈环扎术治疗宫颈功能不全患者的影响

目的 探讨用药护理对盐酸利托君联合紧急宫颈环扎术治疗宫颈功能不全患者的影响。方法 选取2018年1—12月我院收治的孕中期妊娠宫颈机能不全患者60例,随机将其等分为研究组和对照组,对照组给予盐酸利托君联合紧急宫颈环扎术治疗,进行常规护理,研究组在对照组基础上联合用药护理。比较两组患者的术后并发症、用药不良反应、妊娠结局、延长妊娠孕周、实际分娩孕周及新生儿体重。结果 研究组患者术后并发症、不良反应发生率均少于对照组(P 0. 05),妊娠结局优于对照组(P 0. 05),延长妊娠孕周、实际分娩孕周长于对照组(P 0. 05),新生儿体质量高于对照组(P 0. 05)。结论 临床中给予孕中期妊娠宫颈机能不全患者进行治疗过程中,应用盐酸利托君联合紧急宫颈环扎术疗效确切,给予患者用药护理,能显著降低患者术后并发症及用药不良反应的发生率,延长患者孕周,值得临床推广应用。     

预防性宫颈环扎术和紧急性宫颈环扎术治疗宫颈机能不全患者的临床疗效及安全性比较

目的 对比紧急性宫颈环扎术与预防性宫颈环扎术治疗宫颈机能不全的临床疗效。方法 以回顾性分析为法,观察对象为2021年1月至2022年6月入海南医学院第一附属医院的100例宫颈机能不全患者,参考手术时机分为研究组(n=50)与对照组(n=50),研究组行预防性宫颈环扎术治疗,对照组行紧急性宫颈环扎术治疗。比较两组患者的手术相关指标(术中出血量、手术时间、住院时间)、分娩情况(妊娠32周宫颈长度、分娩孕周、妊娠延长时间)、分娩结局(剖宫产、自然分娩)、妊娠结局(足月产率、早产率、流产率)及并发症(胎膜早破、产后出血、宫颈裂伤)发生情况。结果 两组患者手术时间比较差异无统计学意义(P>0.05);研究组患者术中出血量为(30.18±5.33) mL,明显低于对照组[(42.17±5.71) mL],住院时间为(6.81±2.74) d,明显短于对照组[(9.04±2.63) d],差异均有统计学意义(P<0.05)。研究组患者妊娠32周宫颈长度、分娩孕周、妊娠延长时间分别为(2.98±0.32) cm、(37.49±3.97)周、(9.82±2.47)周,均明显长于对照组[(2....     

宫颈环扎术治疗妊娠合并宫颈机能不全的疗效观察及围手术护理

目的 探讨观察宫颈环扎术用于治疗妊娠合并宫颈机能不全的疗效及其围手术期护理。方法 选取85例因妊娠合并宫颈机能不全行宫颈环扎术的患者,观察患者住院天数,术后应用硫酸镁时间,妊娠结局及围手术期护理等方面。 结果 85例患者追踪到妊娠结局的共75例,其中足月产54例(占72%),早产10例(占13.33%),流产11例(占14.67%),10例早产儿追踪到出生后1月均健康存活,故手术成功率为85.3%。 结论 宫颈环扎术是妊娠合并宫颈机能不全的一个重要且有效的治疗方法,术后通过围手术期护理与观察,可延长孕周,改善妊娠结局。     

宫颈环扎术治疗宫颈机能不全的临床研究

目的：探讨宫颈环扎术治疗宫颈机能不全的疗效。方法：分析1996年1月—2009年12月79例因宫颈机能不全行宫颈环扎术患者的临床资料。结果：（1）79例宫颈机能不全患者中76例获得活婴,3例失败,手术总成功率为96.20%。其中26例行选择性宫颈环扎术,成功25例,失败1例。44例行治疗性宫颈环扎术,无一例失败。9例行急诊宫颈环扎术,成功7例,失败2例,成功率为77.78%,明显低于非急诊宫颈环扎术的成功率（96.15%）。（2）与孕20周后相比,孕20周前行选择性环扎术者妊娠天数和新生儿出生体质量明显增加（261.83±9.89d比243.64±26.04d;3106.67±423.14g比2550.36±792.68g）。（3）在治疗性宫颈环扎组和选择性环扎术组中,有3次以上流产史者宫颈环扎后分娩时妊娠天数和新生儿出生体质量明显高于流产次数少于3次者（261.50±10.97d比237.10±27.05d;3025.00±524.81g比2458.50±818.63g）。结论：宫颈环扎术治疗宫颈机能不全疗效肯定;急诊宫颈环扎术是可行的,它可以明显改善宫颈机能不全患者的预后;在孕20周前行选择性环扎术可以明显增长分娩孕周和增加新生儿出生体质量;无论是选择性还是治疗性宫颈环扎,流产3次以上的患者更能从手术中获益。     

中孕早期阴道置水囊结合腹部B超检测宫颈机能临床观察

目的 探讨中孕早期阴道置水囊结合腹部B超检测宫颈机能不全的临床应用.方法 选择中孕14～19周的孕妇45例,通过阴道置水囊暴露宫颈结合腹部B超监测宫颈各径线,对诊断宫颈机能不全者收住入院,予宫颈环扎术,随访受检者孕期、分娩情况.结果 超声诊断宫颈机能正常或不全后行宫颈环扎术者无晚期自然流产发生,初次妊娠与再次妊娠者足月分娩率差异无统计学意义(P＞0.05).结论 中孕早期阴道置水囊结合腹部B超检测宫颈机能可早期发现宫颈机能不全,为临床早诊断、早治疗提供依据;宫颈机能不全的发生与流产次数相关;对初孕曾发生过无痛性晚期流产、早产者再妊娠时应警惕宫颈机能不全的发生.     

多次宫颈环扎术治疗宫颈机能不全的疗效观察

目的:评价多次宫颈环扎术治疗宫颈机能不全的疗效。方法:回顾性分析行单次或多次宫颈环扎术51例的临床资料。结果:(1)多次宫颈环扎术组(A组)的手术成功率明显高于单次宫颈环扎术组(B组)(78.6%vs 38.5%,P0.05);与B组相比,A组终止妊娠的天数、延长妊娠天数及新生儿体重明显增加(248.0±26.9 vs 186.6±54.7)d;(129.9±49.9 vs 55.7±45.6)d;(2527.3+916.3 vs 1289.2+1238.8)g,P均0.05。(2)术后住院组的手术成功率与术后出院组无明显差异(P0.05)。结论:多次宫颈环扎术的疗效优于单次宫颈环扎术,能明显延长孕周及增加新生儿体重:术后住院并不能增加手术成功率。     

Cervical incompetence: the use of transvaginal sonography to provide an objective diagnosis.

OBJECTIVE: To investigate the use of transvaginal sonography in monitoring the cervix in women at high risk of a preterm delivery. STUDY DESIGN: One hundred and six women at high risk of preterm labor had regular cervical monitoring by transvaginal ultrasound throughout pregnancy from the second trimester to delivery. The study was designed to be observational, but intervention was considered if the cervical length fell below 10 mm. RESULTS: Eleven women demonstrated opening of the cervical canal at rest or with fundal pressure before 24 weeks' gestation. Between 2 and 17 days later all 11 cervices progressively shortened to a cervical length of < 10 mm. Nine women had a cervical cerclage. Seven women had fetal membranes visible within the cervical canal at the time of cerclage. One woman miscarried at 18 weeks, and the other 10 had live births at a median gestational age of 36 (range, 27-38) weeks. CONCLUSIONS: Cervical length shortening in the second trimester, once started, progressed to a cervical length under 10 mm. Opening of the cervical os at rest or in response to fundal pressure detected by transvaginal ultrasound appears to be the early ultrasound feature of cervical incompetence.     

宫颈机能不全紧急环扎术的效果评估——附20例临床分析

目的：探讨宫颈紧急环扎术治疗宫颈机能不全（cervical incompetence,CI）的效果。方法：将我院2005-06-2009-12收治妊娠期宫颈机能不全患者20例分为：选择性环扎组7例,紧急环扎组7例,另外6例纳入保守治疗组作为对照（简称对照组）。入院后完善相关检查,全部手术组实施宫颈环扎术及药物保胎治疗,对照组仅给予保胎药物治疗。上述处理后观察5～7d,无流产征兆者出院,规律产检,随访至妊娠终止。观察其平均保胎天数、新生儿出生体重、新生儿存活、〉34周分娩、〉37周分娩、胎膜早破发生情况,对结果进行统计分析。结果：保胎天数：选择性环扎组（154.86±10.51）d,紧急环扎组（34.86±46.84）d,对照组（94.75±30.93）d;新生儿平均出生体重：选择性环扎组（3171.43±424.12）g,紧急环扎组（1557.14±907.11）g,对照组（2812.50±383.79）g;新生儿存活：选择性环扎组7例,紧急环扎组2例,对照组6例;〉34周者分娩：选择性环扎组7例,紧急环扎组2例,对照组6例;〉37周分娩：选择性环扎组4例,紧急环扎组1例,对照组3例;胎膜早破的发生：选择性环扎组0例,紧急环扎组4例,对照组0例。结论：宫颈机能不全是导致妊娠晚期流产和早产的常见原因,预防性宫颈环扎可延长保胎天数、增加〉34周分娩、减少胎膜早破的发生、增加新生儿平均出生体重,但并不能减少早产的发生。对CI的低危患者,保守治疗也能取得较好的妊娠结局和新生儿结局。     

Vaginal ultrasound and cervical cerclage: a prospective study.

Vaginal ultrasound is a new technique for the objective assessment of the pregnant cervix. Twenty patients (21 pregnancies) were scanned at regular intervals throughout pregnancy after cervical cerclage by the vaginal route. Patients were recruited in 2 consecutive years in each of two centers with a low incidence of cervical cerclage (less than 0.5% of all pregnancies). Cervical cerclage, using Mersilene tape inserted by anterior and posterior incisions, positioned the cervical suture in the middle third of the cervical canal in all procedures (21/21). Ultrasound features including dilatation of the internal cervical os and herniation of the gestational sac to the level of the cervical suture were detected in 4/21 pregnancies at 5-7 weeks prior to delivery (21-33 weeks). Six patients (6/21) delivered preterm (< 37 weeks) without ultrasound features associated with cervical incompetence. Eleven patients (11/21) had a closed internal cervical os throughout pregnancy that remained closed after removal of the cervical suture at 38 weeks. In this study ultrasound features associated with cervical incompetence had a sensitivity of 40% and a specificity of 100% in the prediction of preterm pregnancy loss in this group of patients undergoing cerclage. Vaginal ultrasound is a simple, non-invasive technique that permits the detection of ultrasound features associated with cervical incompetence during pregnancy in patients who have had prophylactic cervical cerclage at 14-16 weeks' gestation. Ultrasound features associated with cervical incompetence were rare in this group of patients (4/21 from an overall obstetric population of 8000 deliveries) indicating a prevalence of cervical incompetence in the range of 1 : 1000-1 : 2000 deliveries. In the majority of patients undergoing cerclage (11/21) the clinical diagnosis of 'cervical incompetence' was incorrect as shown by the detection of a normal cervical canal following removal of the suture at 38 weeks.     

Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): effect of therapeutic cerclage with bed rest vs. bed rest only on cervical length.

OBJECTIVE: To compare the effects of therapeutic cerclage and bed rest vs. just bed rest on cervical length and to relate these effects to the risk of preterm delivery. DESIGN: Cervical length was measured in patients at high risk of cervical incompetence. When a cervical length < 25 mm was measured before 27 weeks' gestation, randomization for therapeutic cerclage and bed rest vs. just bed rest was performed. After randomization, cervical length was measured weekly. For statistical analysis, t-test and Fisher's exact tests were used and P < 0.05 was considered statistically significant. RESULTS: Nineteen women were randomly allocated to receive a therapeutic cerclage and bed rest and 16 were allocated to receive bed rest only. Mean cervical lengths and mean gestational ages before randomization were comparable between both groups, overall 19.8 mm and 20.7 weeks. Cervical length was measured again at a mean gestation of 22.1 weeks. Mean cervical length (31 mm) was significantly (P < 0.0001) longer after cerclage than after bed rest only (19 mm). A cervical length > or = 25 mm was measured in 22 of the 35 included women, 16 in the cerclage group and six in the bed-rest group (P = 0.006). Of these 22 women, only one delivered before 34 weeks' gestation, which was significantly less frequent than six out of 13 women with a cervical length < 25 mm (P = 0.006). CONCLUSIONS: Therapeutic cerclage with bed rest increases cervical length more often than bed rest alone. A postintervention cervical length > or = 25 mm reduces the risk of preterm delivery in women at high risk of cervical incompetence and a preintervention cervical length < 25 mm.     

Funneling to the stitch: an informative ultrasonographic finding after cervical cerclage.

OBJECTIVE: The purpose of this study was to evaluate the utility of ultrasound surveillance after cerclage placement and to propose a rationale for cervical sonography in this setting. SUBJECTS AND METHODS: This was a retrospective analysis of 53 women undergoing cervical cerclage by a maternal-fetal medicine specialist, regardless of indication, and delivering between January 1999 and April 2001. Transvaginal ultrasonographic assessment of cervical length and the degree of cervical funneling after cerclage were compared to preoperative values and to outcomes including gestational age at delivery. Funneling to the cerclage was defined as membranes prolapsing down the endocervical canal until they reached the plane of the cerclage. RESULTS: Cervical cerclage resulted in a significant increase in cervical length from 2.1 +/- 1.2 cm to 2.9 +/- 0.8 cm after the procedure, P < 0.001; however, this measure was not correlated with gestational age at delivery. Funneling to the level of the cerclage was associated with an earlier gestational age at delivery 31.3 +/- 5.6 weeks vs. 36.8 +/- 2.8 weeks for those cases without this finding, P < 0.001. A statistically significant association between funneling to the cerclage and preterm delivery was identified irrespective of the indication (prophylactic or emergency) for the procedure. When descent of the membranes to the level of the cerclage was noted, it occurred by 28 weeks' gestation in all patients studied. The incidence of premature rupture of the membranes was also significantly greater postcerclage in women with descent of the membranes to the cerclage (52%) compared to those without this finding (9%) P= 0.002. CONCLUSIONS: Funneling to the cerclage is significantly associated with earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation is useful in identifying patients at higher risk for premature rupture of the membranes and preterm delivery.     

孕期人乳头状瘤病毒感染的结局分析

目的:探讨人乳头状瘤病毒(human papillomavirus,HPV)的感染分型及母婴垂直传播情况。方法:对2011年1月—2012年12月在复旦大学附属中山医院青浦分院产科门诊就诊的500例孕妇的宫颈脱落细胞进行HPV-DNA分型检测,并对HPV阳性孕妇分娩的新生儿的口咽部和生殖器黏膜细胞进行HPV-DNA分型检测,分析HPV亚型感染状况。结果:500例孕妇中HPV阳性者102例,感染率20.40%;感染HPV最常见的亚型为HPV16(4.2%)、HPV52(2.20%)、HPV33(1.80%)、HPV58(1.80%)、HPV18(1.60%)、HPV39(1.20%)。HPV阳性孕妇中,单型别感染88例(86.27%);多重型别感染14例(13.73%),其中二重感染11例,三重感染3例。母婴HPV垂直传播7例(6.86%)。25~30岁年龄段孕妇HPV感染率较高,不同孕期孕妇HPV感染率差异无统计学意义(P0.05)。结论:孕期HPV感染以HPV16型为主,并可母婴垂直传播;妊娠期妇女早期筛查对降低宫颈癌发病率和新生儿感染率非常必要。