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。     

宫颈环扎术治疗宫颈机能不全 30 例临床分析

目的 探讨宫颈环扎术治疗宫颈机能不全引起的习惯性流产和早产的临床效果。 方法 对 30 例孕 15 周~28 周因宫颈机能不全行宫颈环扎术的患者进行回顾性分析。 结果 术后流产 3 例（10%）,早产 3 例（10%）,足月产 24 例（80%）,新生儿存活 27 例（90%）。 结论 宫颈环扎术简单易行,安全可靠。对宫颈机能不全患者及时行宫颈环扎术,可延长宫颈机能不全患者的孕周,提高胎儿存活率,有效降低晚期流产率及早产率。      

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.     

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。     

宫颈环扎术防治早产32例临床分析

目的通过对习惯性流产和早产患者行宫颈环扎术进行临床分析,探讨宫颈内口环扎术治疗孕中期宫颈机能不全的疗效,分析影响手术成功率的相关因素。方法对我院2002年12月至2008年9月收治的宫颈机能不全患者行宫颈环扎术32例临床资料进行回顾性分析。结果32例手术均顺利完成,术后流产3例,早产5例,足月产24例,32例中无一例发生并发症,无一例发生感染。结论宫颈环扎术手术操作简单易行,安全可靠,成功率高,并发症少,术后新生儿存活率高,对宫颈机能不全患者适时实行宫颈内口环扎术,对挽救1次不可避免的胎儿损失,提高妊娠成功率是一种积极有效的治疗方法。孕13—19周手术效果较好,术前诊断明确、适应证掌握得当、手术缝合水平及术后的相关治疗和护理也是提高手术成功率的重要因素。     

宫颈机能不全行宫颈环扎术患者的护理

目的:探讨宫颈机能不全行宫颈环扎术患者的医疗护理对策和妊娠结局。方法:选择2013年9月~2014年10月我院收治的53例宫颈机能不全患者,其中19例行预防性宫颈环扎,34例患者行治疗性、紧急性宫颈环扎。总结治疗和护理方法。结果:53例宫颈机能不全患者,临近足月拆线41例,出现临产征兆或已临产拆线12例;预防性宫颈环扎29例中流产2例,早产3例,足月产24例;治疗性/紧急性宫颈环扎24例中,流产2例,早产10例,足月产12例;新生儿均正常健康,孕产妇无宫颈裂伤,恢复良好。结论:宫颈环扎术有效防治因宫颈机能不全而发生的流产、早产。在护理工作中,除了严密观察病情外,应该熟悉宫颈环扎的各种危险因素及临床表现,通过定时产检和微信平台对患者进行实时正确的健康指导,警惕感染、早产的发生,并及时配合医疗干预,能改善预后。     

宫颈机能不全45例分析

目的 探讨宫颈环扎术治疗宫颈机能不全的临床应用价值.方法 采用MMcDonald宫颈环扎术治疗宫颈机能不全45例,回顾分析其治疗效果.结果 45例患者中2例于孕26周时发生晚期流产,6例于孕35～36周发生早产,新生儿存活.2例因为合并重度妊娠高血压综合征行剖宫产术,新生儿均存活.35例均在36周后拆线,均为阴道分娩,新生儿存活.结论 宫颈环扎术是治疗宫颈机能不全简易、安全、有效以及成功率高的一种手术方法,临床效果满意.     

宫颈环扎术治疗宫颈机能不全103例护理分析

目的:探讨宫颈机能不全行宫颈环扎术治疗的护理.方法:回顾性分析我院2009年1月至2011年6月对103例确诊为官颈机能不全的患者实施宫颈环扎手术的临床护理资料.结果:95例足月顺产和足月剖官产;3例孕28~34周早产,新生儿存活;5例晚期自然流产;3例失访.结论:宫颈环扎术治疗宫颈机能不全疗效满意,正确的护理干预是宫颈环扎手术成功的保障.     

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。     

双胎妊娠宫颈机能不全行阴道宫颈环扎对妊娠结局的影响

目的研究阴道宫颈环扎治疗双胎妊娠宫颈机能不全的效果及对妊娠结局的影响。方法采用回顾性研究方法,选择2015年1月至2020年1月秦皇岛市妇幼保健院收治的50例单胎妊娠宫颈机能不全患者与50例双胎妊娠宫颈机能不全患者,分别设定为对照组与研究组,两组均选用经阴道宫颈环扎术治疗,比较两组患者的手术指标、妊娠情况及妊娠结局。结果研究组术中出血量、手术时间、住院时间、术后延长妊娠孕周、终止妊娠孕周、5 min新生儿Apgar评分、新生儿存活率、新生儿体重、足月产率、早产率及流产率依次为(19.32±3.17) ml、(36.71±2.15) min、(3.74±0.57) d、(18.53±1.92)周、(36.84±1.83)周、(7.73±0.38)分、86.00%、(3.02±0.67) kg、58.00%、26.00%、16.00%,对照组依次为(20.08±2.96) ml、(36.95±1.97) min、(3.58±0.55) d、(21.47±1.83)周、(38.39±1.81)周、(9.15±0.42)分、98.00%、(3.51±0.73) kg、78.00%、14.00%、4.00%。两组手术指标(术中出血量、手术及住院时间)、早产率比较,差异无统计学意义(P0.05);研究组较对照组术后延长妊娠孕周、终止妊娠孕周更短,新生儿Apgar评分、新生儿存活率、新生儿体重及足月产率更低,流产率更高,差异均具有统计学意义(P 0.05)。结论双胎妊娠宫颈机能不全行阴道宫颈环扎术治疗的效果良好,但较单胎妊娠宫颈机能不全疗效较差,临床治疗应根据患者实际情况谨慎使用阴道宫颈环扎术。     

网片补丁加固的紧急宫颈环扎术治疗宫颈机能不全的疗效观察

[目的]探讨网片补丁加固的紧急宫颈环扎术治疗妊娠中期宫颈机能不全的疗效.[方法]收集2013年1月至2014年12月本院妊娠中期宫颈机能不全孕妇12例,所有患者均采用网片补丁加固的紧急宫颈环扎术,分析此术式对妊娠结局的影响.[结果]12例孕妇平均延长孕周(12.65±3.82)周;12例孕妇中有8例孕妇获得存活新生儿,成功率67.67％,4例晚期难免流产,3例因远早于早产孕周破水自愿放弃,1例孕妇阴道分泌物有细菌生长,血常规及C反应蛋白(CRP)异常升高,考虑感染而终止妊娠.[结论]采用网片补丁加固的紧急宫颈环扎术可延长孕周,有效改善妊娠结局,值得临床推广.     

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.     

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.     

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.     

Cervicovaginal fistulas: management of subsequent pregnancy

Cervicovaginal fistulas that develop after midtrimester abortion represent a significant risk to subsequent pregnancies. Since patients with this condition appear to be at increased risk for preterm labor and cervical incompetence, I recommend a cerclage procedure. The probability of complications during labor in such cases makes elective cesarean delivery the method of choice.     

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 cerclage: a ten-year review in a large hospital

This retrospective study of 129 pregnancies treated with cervical cerclage was done to analyze differences, if any, in reproductive outcome according to gestational age, race, history of previous successful pregnancy, gravidity, and procedure used (McDonald vs Shirodkar cerclage). Fetal salvage was significantly improved only when cerclage was done before 18 weeks of gestation. Cervical cerclage between 18 and 26 weeks' gestation significantly increased the prematurity rate. Cervical cerclage significantly improved fetal salvage in both the black and white populations but at the expense of increasing the prematurity rate in the former. There was no difference in fetal salvage whether the patient had had a previous successful pregnancy or not, or whether the patient was a primigravida or multigravida. Fetal salvage was significantly improved with both the McDonald and Shirodkar procedures, with no significant differences in the complication, prematurity, or cesarean section rates.