子宫颈机能不全合并中重度宫腔粘连的处理

目的 探讨子宫颈机能不全合并中重度宫腔粘连患者的诊断和治疗经验.方法 回顾性分析2017年9月至2019年12月在中南大学湘雅三医院诊治的11例子宫颈机能不全合并中、重度宫腔粘连患者的诊断和治疗的相关资料,并随访治疗后的妊娠结局.结果 11例患者术前均有典型的中孕期无痛性子宫颈扩张病史,其中7例宫腔镜术前子宫颈内口可无...

Management of cervical incompetence combined with moderate to severe intrauterine adhesions

Objective To explore the experience in diagnosis and treatment of cervical incompetence combined with moderate to severe intrauterine adhesions.Methods Totally 11 patients with cervical incompetence combined with moderate to severe intrauterine adhesions were diagnosed,treated and followed up at the Third Xiangya Hospital of Central South University from September 2017 to December 2019,and their medical records and the pregnancy outcomes were retrospectively analyzed.Results All patients had a history of typical painless cervical dilatation during the second trimester before surgery.In 7 patients,the No.7 Hegar dilator was able to pass through the inner orifice of the cervix before surgery without resistance.In the other 4 patients,the Hegar dilator could not be inserted before surgery due to the adhesions of the cervical canal and the lower uterine segment;the diagnoses of these patients were further confirmed at 3 months after hysteroscopic adhesiolysis when the No.7 Hegar dilator was able to pass through the inner orifice of the cervix without resistance.The pregnancy rate was 63.6%(7/11),6 had delivered,the live birth rate was100%,and another one was 11 weeks pregnant now with no discomfort.Conclusion In patients with cervical incompetence combined with cervical or lower segment intrauterine adhesions,it is necessary to separate the adhesion prior to evaluating the cervical competency with the No.7 Hegar dilator to confirm the diagnosis.Pre-pregnancy laparoscopic cervical cerclage has a good prognosis in patients with cervical incompetence complicated by moderate to severe intrauterine adhesions.