The short and funneling cervix: when to use cerclage?

PURPOSE OF REVIEW: The diagnosis of cervical incompetence remains extremely difficult because there is no diagnostic test available prior to, during or after pregnancy. This review will summarize the latest publications on the use of transvaginal ultrasonography to identify women at high risk of preterm delivery and the use of cervical cerclage in these women. RECENT FINDINGS: Cervical length is not only inversely related to the risk of preterm delivery but also inversely related to the risk of intrauterine infection in women with preterm labor. Furthermore, previous history of preterm delivery is related to the risk of preterm delivery. Cerclage trials on women with short cervical length present conflicting results both in low and high-risk populations. Assessment of risk factors and obstetric history remain important in the diagnosis of cervical incompetence. Women at high risk of preterm delivery due to cervical incompetence should be followed-up with transvaginal measurements of cervical length. Only a minority of these women will develop a short cervical length and will consequently be at high risk of preterm delivery. SUMMARY: A combination of assessment of risk factors, obstetric history and follow-up of cervical length enables us to identify women who benefit from a cervical cerclage.     

Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies: does cerclage prevent prematurity?

OBJECTIVES: We sought to determine the predictive accuracy for preterm delivery of transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation in high-risk patients and to determine whether cerclage prevents preterm delivery in patients with ultrasonographic cervical changes. STUDY DESIGN: Patients with asymptomatic singleton pregnancies at high risk for preterm delivery were followed prospectively from 14 weeks' to 23 weeks 6 days' gestation with transvaginal ultrasonography of the cervix. The subgroup of patients with either a cervical length of <25 mm or funneling of >25% or both was offered McDonald salvage cerclage, which was performed at the discretion of the patient and the obstetrician. The 2 groups (with and without cerclage) were compared for the primary outcome of preterm delivery at <35 weeks' gestation. RESULTS: One hundred sixty-eight women were followed, including 97 (58%) with >/=1 prior 14- to 34-week preterm deliveries. Of 63 (37. 5%) patients identified as having cervical changes, 23 (37%) had preterm delivery; of 105 patients with no cervical changes, 8 (8%) had preterm delivery (relative risk, 4.8; 95% confidence interval, 2. 3-10.1). The sensitivity, specificity, and positive and negative predictive values of either a short cervix of <25 mm or funneling of >25% or both were 74%, 70%, 37%, and 92%, respectively. Of 63 pregnancies in which there were cervical changes, 39 underwent cerclage and 24 did not. These 2 groups were similar for demographic characteristics, risk factors, and transvaginal ultrasonographic cervical length and funneling but dissimilar for gestational age at identification of cervical changes (18.3 vs 21.2 weeks' gestation in the groups with and without cerclage, respectively; P <.001). Multivariate logistic regression analysis after adjustment for gestational age at cervical changes showed no difference in the rate of preterm delivery between the groups with and without cerclage (odds ratio, 1.1; 95% confidence interval, 0.3-4.6). Stratified analysis of patients identified between 18 and 24 weeks revealed 22 pregnancies with cerclage and 22 pregnancies without cerclage, which was similar for all characteristics studied. The incidence of preterm delivery remained similar (27% vs 23%, respectively; P =.7), as did days from cervical changes to delivery (111 vs 96, respectively; P =.2). CONCLUSIONS: Transvaginal ultrasonography of the cervix between 14 and 24 weeks' gestation is a good predictor of preterm delivery in high-risk pregnancies. Cerclage may not prevent preterm delivery in patients identified to be at high risk for this outcome by transvaginal ultrasonography.     

Controversies regarding cervical incompetence, short cervix, and the need for cerclage

Cervical incompetence (CI) is not an all or nothing phenomenon but a continuous variable. CI and preterm labor are not distinct entities but rather part of a spectrum leading to preterm delivery. Cervical length (CL) is an independent variable in the prediction of preterm delivery, to which it is inversely related. Application of a primary transvaginal cervical cerclage appears to be an unnecessary intervention in about 50% of women presenting with a history suggesting cervical incompetence. A better alternative for women with a history of or risk factors for CI is transvaginal ultrasonographic follow-up of CL. To facilitate the comparison of studies of CI, the authors suggest a nomenclature reflecting the different stages of prevention: primary, secondary, and tertiary transvaginal cervical cerclage.     

Transvaginal ultrasonography of the cervix length and the prediction of preterm delivery

OBJECTIVE: To determine if cervical shortening between 12 and 28 weeks gestation predicts risk of spontaneous preterm birth or cervical funneling requiring cerclage. STUDY DESIGN: We reviewed retrospectively all the patients who had transvaginal cervical ultrasound assessment during one year. 43 patients who had a second and early third trimester delivery or cerclage placement were chosen for the study. The control group consisted of 78 patients without signs of preterm labor and cervical shortening as assessed by transvaginal ultrasound. The results of the last ultrasound cervical length measurement were correlated with the likelihood of preterm delivery or cervical funneling requiring cerclage. RESULTS: 26 of 121 patients studied delivered preterm and 15 required cervical cerclage because of cervical shortening and funneling. The mean cervical length assessed by ultrasound was 23.22 +/- 3.07 mm in the group with preterm contractions and delivery and 21.99 +/- 7.05 mm in the group with cervical incompetence. In the normal pregnancy group mean cervical length was 35.59 +/- 3.07 mm. CONCLUSIONS: Cervical length of < 3.0 cm and further shortening of the cervix is predictive of preterm delivery or cervical incompetence requiring cerclage.     

Does cervical cerclage prevent preterm delivery in patients with a short cervix?

OBJECTIVE: Our purpose was to determine whether cerclage placement in women with a short cervix on transvaginal ultrasonography reduces the rate of preterm delivery. STUDY DESIGN: A retrospective cohort study identified patients with an ultrasonographic short cervix (cervical length < or =15 mm) between 14 and 24 weeks' gestation. Cerclage placement was performed at the discretion of the attending physician. Clinical characteristics and outcome with and without cerclage were compared. RESULTS: Seventy patients met inclusion criteria; 25 (36%) underwent cerclage placement. Patients managed with cerclage had a lower gestational age at diagnosis (19.6 weeks vs 21.3 weeks, P <.01) but had a similar median cervical length, presence of funneling, and a history of cervical surgery, in comparison with those managed without cerclage. The rate of spontaneous preterm delivery was not different between groups. Patients with cerclage had a higher rate of preterm premature rupture of membranes than those without cerclage (65.2% vs 36.4%, P <.05). CONCLUSION: Cervical cerclage in patients with a short cervix did not reduce the rate of spontaneous preterm delivery and increased the risk of preterm premature rupture of membranes.     

Noninvasive cerclage for the management of cervical incompetence: a prospective study

Objective: The aim of this study was to evaluate the efficacy and safety of a noninvasive cerclage pessary in the management of cervical incompetence. Methods: This is a prospective cohort study of all pregnant women treated for cervical incompetence during a 4-year period. Women with known risk factors for preterm delivery had transvaginal ultrasonography every 2–3 weeks after 17–19 weeks of gestation. Those with progressive shortening of cervix diagnosed before 30 weeks were treated with a cerclage pessary when the cervical length was ≤25 mm. The pessary was electively removed at 34–36 weeks. The course and outcome of pregnancy were recorded. Results: Thirty-two women were treated with a cerclage pessary. There were nine twin and two triplet pregnancies. Fifteen (47%) had two or more risk factors for preterm delivery. The mean gestational age at cerclage was 23 (17–29) weeks, cervical length 17 (5–25) mm. Two women required delivery before the onset of labor due to severe intrauterine growth restriction and one due to HELLP syndrome. These were excluded from further analysis. In the remaining 29 women, the interval between cerclage and delivery was 10.4 (2–19) weeks, mean gestational age at delivery 34 (22–42) weeks, and birth weight 2,255 (410–4,045) g. Thirteen (45%) women delivered before 34 weeks. There were a total of 35 live-born infants and four intrapartum fetal deaths (all between 22 and 25 weeks gestation). All women complained of increased vaginal discharge, but no other significant complications were observed that could be attributed to the use of pessary. Conclusion : Cerclage pessary may be useful in the management of cervical incompetence. Whether it can be a noninvasive alternative to surgical cerclage merits further investigation.     

Zervixinsuffizienz – diagnostische, präventive und therapeutische Aspekte

Common attributes of preterm delivery are cervical insufficiency, premature contractions and rupture of membranes. The development of clinical symptoms depends on the cause and dynamics of these factors. Tocolysis has not succeeded in prolonging pregnancy in such a way as to decrease the rate of prematurity. In the future, we must learn to recognize the first symptoms in a reversible instead of in an irreversible phase. The ultrasonographic structure of the cervix (length and funneling) determines more than just the clinical findings or the number of contractions the interval until delivery. We found that transvaginal ultrasonography in a standing position combined with fibronectin improves the prediction of preterm birth in risk groups. There are only a few controlled studies on the prevention or treatment of cervical incompetence. Among women with bacteriuria, a previous preterm birth and bacterial vaginosis, antibiotic treatment reduces the risk of another such event. On the basis of our own ultrasound normal values we indicate the use of a vaginal pessary. In cases with repetitive preterm labor we recommend a Shirodkar cerclage. In cases with substantial loss of cervical tissue we recommend an abdominal cerclage and in cases with complete dilatation at an early gestational age we recommend “active expectant management” or in cases with multiple pregnancy delayed interval delivery.     

Cervical incompetence prevention randomized cerclage trial (CIPRACT): study design and preliminary results

OBJECTIVE: The objective of this study was to compare different management strategies for women at risk for cervical incompetence. STUDY DESIGN: In an ongoing randomized trial patients with a previous preterm delivery at <34 weeks' gestation who met clinical criteria for the diagnosis of cervical incompetence are allocated to receive a prophylactic cerclage (prophylactic cerclage group) or not (observational group) in a proportion of 1:2. Transvaginal ultrasonographic follow-up examination of the cervix is performed in both groups. When a patient of the latter group has a cervical length <25 mm at <27 weeks' gestation, a further random assignment of therapeutic cerclage or no cerclage is performed. The analysis is by intent to treat. RESULTS: Primary random assignment allocated 23 women to the prophylactic cerclage group and 44 to the observational group. Both groups were comparable with respect to obstetric history. No significant difference was found between the prophylactic cerclage group and the observational group in preterm delivery at <34 weeks' gestation (3/23 vs 6/44, respectively) and neonatal survival (21/23 vs 41/44, respectively). A cervical length <25 mm was found in 18 patients (41%) in the observational group at a mean gestational age of 19.1 +/- 2.9 weeks' gestation. Incidence of preterm delivery at <34 weeks' gestation was significantly higher in the group with short cervical length (6/18 vs 0/26; P =.003). Secondary random assignment of the 18 patients with short cervical length allocated 10 to undergo therapeutic cerclage. Preterm delivery at <34 weeks' gestation was significantly less frequent in the therapeutic cerclage group (1/10 vs 5/8). CONCLUSION: Transvaginal ultrasonographic serial follow-up examinations of the cervix in women at risk for cervical incompetence, with secondary intervention as indicated, appears to be a safe alternative to the traditional prophylactic cerclage. Transvaginal ultrasonographic follow-up examination of the cervix can save the majority of women from unnecessary intervention. Placement of a therapeutic cerclage may reduce the incidence of preterm delivery at <34 weeks' gestation among high-risk patients.     

Vaginal sonography and cervical incompetence

Uterine contractions, decidual activation, and cervical competence comprise the fundamental components in contemporary models of the spontaneous preterm birth syndrome, but their relative importance and interactive pathways remain poorly defined. Moreover, the traditional concept that the cervix is either competent or incompetent has been challenged because cervical competence more likely functions along a biologic continuum. Cervical incompetence is a clinical diagnosis characterized by recurrent painless dilation and spontaneous midtrimester birth. Although the efficacy of cerclage for cervical incompetence has never been fully confirmed in randomized clinical trials, the role of cerclage has been expanded to include women with "risk factors" for spontaneous preterm birth or nonreassuring sonographic cervical findings in the mid trimester. Evidence from randomized trials suggests that cerclage has limited efficacy in women with risk factors for cervical incompetence. Results of both retrospective cohort series and randomized trials of cerclage in women with shortened cervical length are inconclusive. We believe that women with a prior early spontaneous preterm birth and shortened midtrimester cervical length represent an ideal population for the conduct of a randomized trial of cerclage, which is currently underway.     

Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.

OBJECTIVE: To compare preterm delivery rates (before 34 weeks of gestation) and neonatal morbidity and mortality in patients with risk factors or symptoms of cervical incompetence managed with therapeutic McDonald cerclage and bed rest versus bed rest alone. STUDY DESIGN: Cervical length was measured in patients with risk factors or symptoms of cervical incompetence. Risk factors for cervical incompetence included previous preterm delivery before 34 weeks of gestation that met clinical criteria for the diagnosis of cervical incompetence, previous preterm premature rupture of membranes before 32 weeks of gestation, history of cold knife conization, diethylstilbestrol exposure, and uterine anomaly. When a cervical length of <25 mm was measured before a gestational age of 27 weeks, a randomization for therapeutic cerclage and bed rest (cerclage group) or bed rest alone (bed rest group) was performed. The analysis is based on intention to treat. RESULTS: Of the 35 women who met the inclusion criteria, 19 were allocated randomly to the cerclage group and 16 to the bed rest group. Both groups were comparable for mean cervical length and mean gestational age at time of randomization, mean overall 20 mm and 21 weeks. Preterm delivery before 34 weeks was significantly more frequent in the bed rest group than in the cerclage group (7 of 16 vs none, respectively; P =.002). There was no statistically significant difference in neonatal survival between the groups (13 neonates survived in the bed rest group vs all in the cerclage group). The compound neonatal morbidity, defined as admission to the neonatal intensive care unit or neonatal death, was significantly higher in the bed rest group than in the cerclage group (8 of 16 vs 1 of 19, respectively; P =.005; RR = 9.5, 95% CI, 1.3-68.1). CONCLUSIONS: Therapeutic cerclage with bed rest reduces preterm delivery before 34 weeks of gestation and compound neonatal morbidity in women with risk factors and/or symptoms of cervical incompetence and a cervical length of <25 mm before 27 weeks of gestation.     

Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data

OBJECTIVE: Preterm birth is the main cause of perinatal morbidity and mortality. A short cervical length on transvaginal ultrasonography predicts preterm birth. Our aim was to estimate by meta-analysis of randomized trials whether cerclage prevents preterm birth in women with a short cervical length. DATA SOURCES: MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched with the terms "cerclage," "cervical cerclage," "short cervix," "ultrasound," and "randomized trial." We included randomized trials involving the use of cerclage in women with short cervical length on transvaginal ultrasonography using patient-level data. TABULATION, INTEGRATION, AND RESULTS: Four properly conducted trials were identified. In the total population, preterm birth at less than 35 weeks of gestation occurred in 29.2% (89/305) of the cerclage group, compared with 34.8% (105/302) of the no-cerclage groups (relative risk [RR] 0.84, 95% confidence interval [CI] 0.67-1.06). There was no significant heterogeneity in the overall analysis (P = .29). There was a significant reduction in preterm birth at less than 35 weeks in the cerclage group compared with the no-cerclage groups in singleton gestations (RR 0.74, 95% CI 0.57-0.96), singleton gestations with prior preterm birth (RR 0.61, 95% CI 0.40-0.92), and singleton gestations with prior second-trimester loss (RR 0.57, 95% CI 0.33-0.99). There was a significant increase in preterm birth at less than 35 weeks in twin gestations (RR 2.15, 95% CI 1.15-4.01). CONCLUSION: Cerclage does not prevent preterm birth in all women with short cervical length on transvaginal ultrasonography. In the subgroup analysis of singleton gestations with short cervical length, especially those with a prior preterm birth, cerclage may reduce preterm birth, and a well-powered trial should be carried out in this group of patients. In contrast, in twins, cerclage was associated with a significantly higher incidence of preterm birth.     

Cervical cerclage and evidence-based medicine: if, how and when

Cervical cerclage has always been the main treatment option in cases of so-called cervical insufficiency, a condition that is notoriously associated with a high risk of second trimester abortion and/or preterm delivery. We can distinguish between a prophylactic cerclage, to be performed electively, usually at 13-16 weeks gestation, only when the woman has a history extremely suggestive for cervical incompetence (3 or more mid-trimester abortions or preterm deliveries) and a therapeutic cerclage. This last cerclage is recommended either for women who have ultrasonographic changes consistent with a short cervix or the presence of funneling after the 16-20 weeks gestation (urgent cerclage) and for women who present the asymptomatic dilation of the uterine cervix of at least 2 cm and/or a prolapse of the amniochorial membranes (emergent cerclage). So far there is still a lack of controlled and randomized trials that can unquestionably demonstrate the advantages of the cervical cerclage in comparison with a 'wait and see' aptitude. The cerclage can be performed either transvaginally, usually according to the McDonald technique, or transabdominally. This last approach is recommended when a transvaginal cerclage has to be avoided because of technical difficulties depending on the conditions of the cervix or when the pregnant woman has a history of one or more failed transvaginal cerclages. Interesting perspectives are currently offered by the laparoscopic cerclage, a method that has been effective and unexpectedly safe till now.     

Short cervix syndrome: current knowledge from etiology to the control

Background

Preterm delivery is one of the most serious public health problems and is the most important factor relating to neonatal morbidity and mortality. The strategies for preventing it include understanding the risk factors, with specific interventions. Recently, uterine cervix measurements using ultrasonography and vaginal administration of progesterone have gained importance in predicting and secondarily preventing spontaneous preterm delivery.

Objective

To describe the short cervix syndrome, including its etiology, diagnosis, and possible therapies.

Methods

Research in ISI, Pubmed, and Scielo database using the words short cervix, preterm delivery, sludge, cervical funneling, cervical gland area, progesterone, cerclage, and pessary.

Results

We found a lot of articles about this topic, including randomized controlled trials. The etiology is multifactorial, being the diagnosis based in a cervix shortening at 20–24 weeks. The history and measurement of cervix length by transvaginal ultrasound have been shown to be effective to select the high risk pregnancies. The progesterone, cervical cerclage, and cervical pessary showed to be effective to reduce the preterm delivery in pregnant women with short cervix.

Conclusion

The successful management of pregnant women presenting a short cervix depends on the understanding that cervical shortening is the final common path for several causes of preterm delivery. The best approach should be individualized to each patient.     

Clinical management of the short cervix

Cervical cerclage is associated with prolongation of gestation in singleton pregnancies with prior spontaneous preterm delivery and a short cervix on vaginal ultrasonography in the mid-trimester. Ultrasound screening of cervical length is not indicated in low-risk singleton pregnancies and in women with multiple gestations. 17α-Hydroxyprogesterone does not prevent preterm delivery in twin gestations with a short cervix. Cervical cerclage may cause detrimental effects in twin gestations. Vaginal pessary for the prevention of preterm birth in women with a short cervix is currently under active investigation.     

Zervixinsuffizienz: operative Möglichkeiten

In recent years, the incidence of operations at the uterine cervix to prevent miscarriages and preterm deliveries has declined steadily. In Berlin, the rate is now well below 1% of all pregnancies. Obviously, the cause lies in the indication and not the operation itself. The operations are based on two premises: (1) a cerclage can prevent premature opening of the cervix due to cervical incompetence and (2) operative occlusion of the cervical canal can prevent transcervical infections following incomplete mucous sealing of the cervical canal or as a consequence of cervical lacerations. Cervical incompetence in the classical sense is an extremely rare finding. In women deemed to be at increased risk of cervical incompetence, cerclage was not found to prolong pregnancy significantly. It is still unclear whether cervical cerclage can improve outcomes in pregnancies with decreased cervical length or dilation of the internal os as detected by vaginal ultrasound. Indications and outcomes of the rare cervix occlusion operations have not as yet been studied in prospective randomized trials. In spite of this, some results suggest that women with a history of repeated miscarriages caused by ascending infections due to sealing deficits of the cervical canal may profit from an operation.     

Universal maternal cervical length screening during the second trimester: pros and cons of a strategy to identify women at risk of spontaneous preterm delivery

Three large randomized controlled trials investigating the efficacy of universal cervical length screening and treatment with vaginal progesterone or cervical cerclage to prevent preterm delivery have been published over the past several years. None of these trials demonstrate proven efficacy for universal cervical length screening and cerclage placement in women with short cervical length. However, universal cervical length screening and treatment with daily vaginal progesterone in women with short cervical length reduces the risk of preterm birth, but large numbers of women must be screened to prevent a relatively small number of preterm deliveries. Issues that should be considered while implementing universal cervical length screening include: (1) standards of quality and reproducibility for transvaginal ultrasound cervical length ascertainment; (2) implications of screening on the application of therapeutic strategies to populations not known to benefit (so-called "indication creep"); and (3) willingness of obstetricians to prescribe vaginal progesterone formulations that are not approved by the US Food and Drug Administration for preterm birth prevention. Optimal strategies to employ cervical ultrasound and progesterone treatment might be revealed by additional studies investigating cervical length cutoffs, frequency of screening, selective screening in higher-risk groups, and the use of transabdominal cervical length screening as a surrogate for transvaginal cervical length screening.     

Verhinderung von Spätaborten und Frühgeburten

Operations at the uterine cervix to prevent miscarriages and preterm deliveries are based on two premises: (1) a cerclage can prevent premature opening of the cervix due to cervical incompetence and (2) operative occlusion of the cervical canal can prevent transcervical infections following incomplete narrowing of the internal os, insufficient mucous sealing of the cervix, or as a consequence of cervical lacerations. Cervical incompetence in the classic sense is an extremely rare finding. In women deemed to be at increased risk of cervical incompetence, cerclage was not found to prolong pregnancy significantly. It is still unclear whether cervical cerclage can improve outcomes of pregnancies in women with decreased cervical length or dilation of the internal os as detected by vaginal ultrasound. Indications and outcomes of the rare cervix occlusion operations have not as yet been studied in prospective randomized trials. In spite of this, some results suggest that women with a history of repeated miscarriages caused by ascending infections due to sealing deficits of the cervix may profit from an operation.     

Ultrasonic assessment of cervix in "at risk" patients

One hundred seventy patients were considered to be at risk of cervical incompetence from their previous history. They were scanned serially from the first trimester to 36 weeks gestation. Of the 170, 105 patients (61.8%) were found to have defective cervix (the length of cervix, width of the cervix, and cervical canal at the level of the internal cervical os, and herniation of amniotic membrane with or without fetal parts into the cervical canal). Of the 105 patients diagnosed to have defective cervix (possible cervical incompetence), 22 patients (21%) aborted, 48 patients (45.7%) had to have cervical cerclage, 26 patients (24.8%) had preterm delivery and the remaining 9 patients (8.5%) had no problems during pregnancy. The remaining 65 patients (38.2%) did not have ultrasonic evidence of cervical incompetence and 3 aborted and only 2 patients delivered between 35 and 37 weeks gestation while 60 patients delivered between 37 and 42 weeks gestation. These 65 patients would have had cervical cerclage on the basis of the clinical history alone, but in only 6, cervical cerclage was inserted.     

《ACOG宫颈环扎术治疗宫颈机能不全指南》解读

宫颈机能不全(cervical incompetence,cervical insufficiency,incompetent cervix)是临床诊断性疾病,但其诊断十分模糊,缺乏客观的金标准。医学文献中关于宫颈机能不全的病理生理、筛查、诊断和处理存在争议。2014年2月美国妇产科学会(The American College of Obstetricians and Gynecologists,ACOG)颁布了宫颈环扎术治疗宫颈机能不全指南文件,具有较强的临床实用性。该指南系统复习和汇总了有关宫颈机能不全的定义、病因、诊断、治疗选择中非手术治疗方法及手术治疗,手术的临床注意事项与建议,不宜推荐宫颈环扎术的病情,宫颈环扎术的并发症,增加围手术期干预及术后B超随访评估的意义,无并发症Mc Donald术拆除缝线的时机,未足月前胎膜早破宫颈环扎缝线拆除与保留的选择及早产宫颈环扎缝线拆除与保留的选择等问题的文献依据及证据等级。笔者指出国内目前尚无治疗宫颈机能不全的指南,一般比较强调卧床休息和宫颈环扎手术治疗,欧美国家对宫颈环扎手术的施行,较国内妇产科医生更为慎重。     

改良阴式子宫峡部环扎术的应用

宫颈机能不全是导致中晚期流产和早产的重要原因,宫颈环扎术作为治疗宫颈机能不全的主要手段广泛应用于临床,经阴道子宫峡部环扎手术操作简便、有效,同时避免了经腹环扎术需再进腹拆线的弊端。本文就经阴道子宫峡部环扎术适应证、手术操作、手术时机及并发症进行相关阐述。