双胎妊娠两次经阴道宫颈环扎成功分娩一例并文献复习

宫颈机能不全是导致妊娠晚期反复流产和早产的主要原因之一。早产可增加围生期发病率与死亡率,给妊娠妇女及家庭带来严重心理和经济负担。目前在国内外,宫颈环扎术被推荐使用于单胎妊娠,对其在双胎妊娠中的应用报道较少,指征不明确。回顾分析1例双胎妊娠经2次宫颈环扎术获2名健康活婴的病例资料并进行文献复习,探讨宫颈环扎术在双胎妊娠中的应用。     

探讨宫颈环扎术后的护理

目的：探讨宫颈环扎术后的最佳护理模式。方法：对106例宫颈机能不全、双胎妊娠、中央性前置胎盘、晚期难免流产的孕妇行宫颈环扎手术;术前及术后对患者进行心理辅导,术后进行常规护理。结果：术前让患者对手术的必要性、手术方法及及预后有一定了解,以最佳心理状态接受治疗。术后同正常妊娠一样护理,日常活动不受限制,多左侧卧位休息。患者同样能得到良好的妊娠结局。结论：宫颈环扎术后患者无需绝对卧床休息,保持健康的心理更为重要。     

捆绑带对骨折愈合影响的实验研究

目的：观察捆绑带对动物模型骨折愈合过程中是否存在相关的影响因素,为临床应用提供依据。方法：30只新西兰大白兔随机分为两组,建立股骨干非负重骨折动物模型,对照组和实验组均采用髓内固定,实验组在骨折部位加用捆绑带捆绑固定,于术后2、4、6周行大体观察、骨密度测定、骨痂前后直径、组织学等检查进行比较,观察捆绑带在骨折固定中的作用及对骨折愈合的影响。结果：对照组在各观察时段各有1例出现骨折移位或畸形愈合。术后2、4周捆绑带组外骨痂相对少,两组在骨密度测定、骨痂前后直径无差别;术后4周捆绑带组光镜下新生骨小梁生长优于对照组,成骨细胞数多于对照组;术后6周对照组骨密度测定、骨痂前后直径明显大于捆绑带组,有明显统计学差异（t=4．243,15．909,P〈0．05～0．01）;光镜下捆绑带组骨痂较对照组显示更成熟并开始向板层骨转化,骨结构更致密,骨小梁排列更整齐。结论：在保持适宜的束缚力的情况下,捆绑带可以有效地维持骨折部位的稳定,避免出现骨折移位或畸形愈合,保障骨折正常的愈合,对于骨膜以及骨折部位血运没有异常的影响。     

紧急宫颈环扎术联合阿托西班在宫颈机能不全治疗中的临床价值

目的：评价紧急宫颈环扎术联合阿托西班在治疗宫颈机能不全中的临床价值。方法：回顾性分析2013年1月-2015年12月于河南省人民医院因宫颈机能不全行紧急宫颈环扎手术,并使用阿托西班保胎的27例患者作为研究对象,观察紧急宫颈环扎术联合阿托西班治疗宫颈机能不全的疗效、妊娠结局和药物不良反应。结果：应用紧急宫颈环扎术联合阿托西班延长孕周（8.6±5.4）周,分娩孕周为（31.8±4.7）周,成功率为74.1%（20/27）,应用阿托西班后抑制宫缩的有效率为62.9%（17/27）。仅有3例患者出现短时间轻微恶心、呕吐症状,1例出现轻微头痛,未出现因不良反应停止阿托西班治疗的情况。结论：紧急宫颈环扎术联合阿托西班能明显延长妊娠时间,妊娠结局良好,药物不良反应发生率低。     

捆绑带使用与骨折愈合障碍相关因素临床对比分析

目的 探讨应用捆绑带治疗长骨骨折出现的骨折愈合障碍与捆绑带的使用以及与骨折类型的相互关系.方法 选取三家医院2004年12月至2009年12月205例因长管状骨骨折住院治疗的患者,对采用钢板、髓内针以及髓内针结合捆绑带的手术治疗病例进行研究,按骨折部位、AO骨折分型及手术方式进行分组.对所有病例进行随访,随访时间6～26个月,平均随访时间(22.3±3.3)个月.出现延迟愈合7处,不愈合12处,对采用不同治疗方式以及不同骨折类型的骨折愈合效果差别进行统计分析.结果 相同部位采用不同的内固定治疗方法,骨折的延迟愈合或不愈合率无统计学差异(P＞0.05),不同的骨折类型手术后,骨折延迟愈合或不愈合率存在统计学差异(P＜0.05),其中C型骨折延迟愈合或不愈合率最高,B型骨折其次.而在C型骨折中采用不同的内固定治疗方法对比分析结果,骨折延迟愈合或不愈合率无统计学差异.结论 捆绑带的使用对骨折愈合无明显不良影响,骨折愈合结果与骨折分型密切相关,与捆绑带的应用没有必然联系.     

Cervical dilation as a predictor of pregnancy outcome following emergency cerclage

Objective: To determine whether cervical dilation at the time of physical examination indicated cerclage placement can predicts latency and gestational age at delivery. Methods: A retrospective cohort study of all women who underwent physical examination indicated cerclage placement from 1996 to 2011 at Duke University Hospital (DUH) was performed. Physical examination indicated cerclage was defined as cerclage placement after 16 weeks in women with a cervical length of less than 2.5?cm and/or cervical dilation greater than or equal to 1?cm at time of procedure. Subjects were divided into two groups depending on cervical dilation at time of procedure (≥2?cm, <2?cm) for comparison. A multivariate linear regression model for the outcome gestational age of delivery was constructed, controlling for confounding variables. Results: A total of 110 women with complete data were available for analysis. Median gestational age at cerclage placement was similar between the two groups (20.3 vs. 20.3 weeks, p?=?0.8). Women with cervical dilatation ≥2?cm dilation delivered at an earlier median gestational age than women with cervical dilation <2?cm (27.0 vs. 35.6 weeks, p < 0.001). Cervical dilation at the time of cerclage placement independently predicted gestational age at delivery while controlling for use of intracervical Foley balloon catheter for membrane reduction, cerclage suture type, history of prior preterm birth, race, insurance status, and tobacco use. Conclusions: Women who receive a rescue cerclage are more likely to deliver at an earlier gestational age when cervical dilation is ≥2?cm at the time of procedure.     

Ultrasound-indicated cerclage: Shirodkar vs. McDonald

Objective: To compare the efficacy of Shirodkar to McDonald cerclage in patients with singleton pregnancies undergoing an ultrasound-indicated cerclage. Methods: Historical cohort of all patients with singleton pregnancies undergoing cerclage for the indication of a short cervix on ultrasound (ultrasound indicated) at one institution in 2005–2010. We compared outcomes based on cerclage type, Shirodkar or McDonald. Outcome measures were gestational age (GA) at delivery, delivery ≥35 weeks, ≥32 weeks, and PPROM. Multivariable regression analysis was performed to control for significant variables. Results: Seventy-four patients with singleton pregnancies underwent an ultrasound-indicated cerclage in the study period (47 Shirodkar, 27 McDonald). Shirodkar was associated with later GA at delivery (mean GA at delivery 36.98 +/? 3.39 vs. 33.34 +/? 6.37 weeks, p = 0.006), a higher likelihood of delivering ≥35 weeks (83 vs. 55.6%, p = 0.011) and ≥32 weeks (91.5 vs. 59.3%, p = 0.001), and a lower likelihood of preterm premature rupture of membrane (PPROM) (13.0 vs. 46.2%, p = 0.002). On adjusted analysis controlling for differing baseline characteristics, Shirodkar remained significantly associated with an increased incidence of delivery ≥32 weeks (odds ratio [OR]: 5.180, 95% CI: 1.024–26.205). Conclusion: Compared to the McDonald technique, the Shirodkar technique was more effective in prolonging pregnancy in patients with singleton pregnancies undergoing ultrasound-indicated cerclage. A prospective trial is needed to compare these two techniques.     

Provider and patient perceptions about dental care during pregnancy

Objective.?To examine the outcome of pregnancies in women with transabdominal cerclage (TAC) and to determine whether aspects of the obstetric history predict failure.

Methods.?This was a cohort study of pregnant women referred for a transabdominal cerclage between 1978 and 2004. Records were reviewed for obstetric history and maternal demographics. Predictor variables were prior pregnancy loss, prior vaginal cerclage, associated factors for TAC, and maternal age. The outcome variable was delivery of an infant beyond 24 weeks who survived the neonatal period. Outcomes were compared using Student's t-test, standard z-test, and Chi-square test.

Results.?Eighty-eight women delivered 96 pregnancies after TAC placement. The fetal salvage rate prior to TAC was 18%, 93% after the procedure (p < 0.001). Delivery beyond 37 weeks occurred in 70% of pregnancies. Maternal age, prior cerclage history, associated factors for TAC, or previous delivery of a viable infant did not predict the eight failures out of the 96 pregnancies.

Conclusion.?Women with TAC had a higher rate of successful pregnancies than prior to TAC. Neither maternal age nor prior pregnancy loss predicted failure. However with such a high success rate, we would have needed 948 women to do so. TAC is an option for women with a poor obstetric history including failed vaginal cerclage.     

The clinical significance of digital examination-indicated cerclage in women with a dilated cervix at 14 0/7-29 6/7 weeks

Objective. This study was to compare pregnancy outcomes between cerclage and expectant management in wemen with a dilated cervix. Design. Retrospective multicenter cohort study. Setting. Five hospitals of Catholic University Medical Center Network in Korea. Population. A total of 173 women between 14 0/7 and 29 6/7 weeks'' gestation with cervical dilation of 1 cm or greater by digital examination. Methods. Pregnancy outcomes were compared according to cerclage or expectant management, with the use of propensity-score matching. Main Outcome Measures. Primary outcome was time from presentation until delivery (weeks). Secondary outcomes were gestational age at delivery, neonatal survival, morbidity, preterm birth, and so on.Results. Of 173 women, 116 received a cerclage (cerclage group), and 57 were managed expectantly without cerclage (expectant group). Cervical dilation at presentation, and the use of amniocentesis performed to exclude subclinical chorioamnionitis differed between two groups. In the overall matched cohort, there was significant difference in the time from presentation until delivery (cerclage vs. expectant group, 10.6±6.2 vs. 2.9±3.2 weeks, p <0.0001). While there was no significant difference in the neonatal survival between two groups, there werelower neonatal morbidity as well as higher pregnancy maintenance rate at 28, 32, 34 and 37 weeks'' gestation in the cerclage group, compared with the expectant group.Conclusion. This study suggests that digital examination-indicated cerclage appears to prolong gestation and decrease neonatal morbidity, compared with expectant management in women with cervical dilation between 14 0/7 and 29 6/7 weeks.