宫颈机能不全在辅助生殖技术中的研究进展

宫颈机能不全（CI）是导致妊娠中晚期流产和早产的重要原因。与自然妊娠女性相比,接受辅助生殖技术（ART）助孕的患者发生CI的风险更高。ART助孕中CI发生的高危因素可能与多囊卵巢综合征（PCOS）、子宫畸形、宫颈机械性损伤、ART助孕药物以及多胎妊娠等有关。可以通过选择单胚胎移植、宫颈操作前充分促软化成熟和体质量管理等措施早期预防。目前临床上CI的治疗方式多样,主要包括卧床休息、阴道使用孕酮、宫颈托和宫颈环扎术等。对于宫颈长度较短的复发性流产患者,在排除CI以外的诱发因素后,推荐在妊娠12~14周行预防性腹腔镜宫颈峡部环扎术,对提高ART助孕临床妊娠率具有重要意义。

Research Progress of Cervical Incompetence in Assisted Reproduction Technology

Cervical incompetence (or cervical insufficiency, CI) is an important cause of miscarriage and preterm delivery in the middle and third trimester of pregnancy. Compared with women who conceived naturally, patients who received assisted reproductive technology (ART) had a higher risk of CI. The high risk factors of CI following ART may be related to polycystic ovary syndrome (PCOS), uterine malformation, cervical mechanical injury, fertility drugs, multiple pregnancies and so on. CI following ART can be early prevented through multiple measures, such as single embryo transfer, full promotion of softening and maturation before cervical operation and weight quality management. At present, there are a variety of clinical treatment methods for CI, including bed rest, vaginal progesterone suppository, cervical bracket and cervical cerclage and so on. For patients with short cervix of recurrent abortion, after excluding the inducing factors of CI, it is recommended that prophylactic laparoscopic uterine cervical isthmus cerclage at 12-14 weeks of pregnancy is of great significance to improve the clinical pregnancy rate of ART.