84例紧急宫颈环扎术临床疗效分析

目的:回顾分析宫颈口已开大和(或)伴有羊膜囊脱出的宫颈机能不全患者实施紧急宫颈环扎术的临床疗效,探讨影响紧急宫颈环扎术成功率的因素.方法:将2016年6月至2019年6月于山东大学齐鲁医院行紧急宫颈环扎术的患者分成3组:宫颈口扩张<3 cm组、≥3 cm且<5 cm组与≥5 cm组,对比分析3组的延长孕周、新生儿存活率...     

紧急宫颈环扎术治疗晚期难免流产40例临床分析

目的探讨紧急宫颈环扎术治疗晚期难免流产的临床价值。方法选取2008年11月至2010年8月中国医科大学附属盛京医院晚期难免流产孕妇65例,40例施行紧急宫颈环扎术,25例未采取手术干预,仅用保胎药物,并卧床休息。统计入院时宫颈情况及术后延长孕周情况。结果 40例紧急宫颈环扎术均成功实施,对产妇无不良影响,平均延长孕期为53.30d。33例患者得存活新生儿。25例未实行紧急宫颈环扎术患者保胎失败23例,发生流产,延长孕期为4.48d。4例患者得存活新生儿。结论紧急宫颈环扎术能有效地延长宫颈机能不全患者的孕周,明显提高新生儿存活率。     

经阴道宫颈环扎术治疗宫颈机能不全21例临床分析

目的 探索宫颈环扎术在宫颈机能不全所致的晚期流产和早产中的临床应用价值。方法 回顾性分析2016年1月至2019年12月,汕尾市人民医院收治21例行宫颈环扎术患者的临床数据（其中有紧急环扎术11例,预防性环扎术10例）。结果 宫颈机能不全孕妇手术21例：足月12例,4例早产,5例流产,这其中胎儿成活16例。结论 宫颈环扎术是孕中晚期宫颈机能不全治疗的有效方法,能延长孕周,是延长孕龄的有效的抗早产手术。     

紧急宫颈环扎术联合网片补丁缝合治疗宫颈机能不全32例临床分析

目的:探讨紧急宫颈环扎术联合网片补丁缝合治疗宫颈机能不全的临床价值。方法:选取2011年1月至2016年8月我院宫颈机能不全孕妇65例,32例施行紧急宫颈环扎联合网片补丁缝合术(A组),33例仅实施紧急宫颈环扎术(B组),对两组延长妊娠的时间、分娩孕周、新生儿结局、分娩方式及术后相关并发症进行比较。结果:A组手术时间长于B组,手术并发症宫颈裂伤A组少于B组,差异均有统计学意义(P0.05);术后两组绒毛膜羊膜炎的发生率差异无统计学意义(P0.05);A组延长孕周84.45±35.77天,B组延长孕周51.86±29.93天,两组比较差异有统计学意义(P0.05);A组≥28周分娩23例(71.88%),B组≥28周分娩17例(51.52%),两组比较差异有统计学意义(P0.05);两组分娩方式比较,差异无统计学意义(P0.05);B组的新生儿出生体质量、出生时Apgar 1分钟评分均低于A组,差异均有统计学意义(P0.05)。结论:紧急宫颈环扎术联合网片补丁缝合能有效延长宫颈机能不全患者的孕周,明显改善新生儿结局,安全性较好,有一定临床应用价值。     

宫颈环扎术治疗孕中期宫颈机能不全的妊娠结局

目的:探讨宫颈环扎术治疗孕中期宫颈机能不全的疗效。方法:36例孕14-28周合并宫颈机能不全,采取宫颈环扎术治疗。结果:孕14-16周手术27例,延长妊娠时间至足月21例,早产3例,流产3例,胎儿成活23例;>16孕周手术9例,延长妊娠时间至足月4例,早产3例,流产2例,胎儿成活6例,两者无统计学差异(P>0.05)。结论:孕14-16周是宫颈环扎术最佳手术时机,>16孕周手术也可提高胎儿成活率,紧急宫颈环扎术是必要的,可以延长妊娠时间,提高活婴分娩率。     

67例紧急宫颈环扎术疗效及影响因素分析

目的:评价紧急宫颈环扎术的治疗效果及影响因素。方法:回顾性分析2007年1月至2012年12月于中山大学孙逸仙纪念医院确诊为宫颈机能不全,宫口开大1~7 cm并行紧急宫颈环扎术的67例患者的临床资料,并比较手术成功组(44例)和失败组(23例)的影响因素。结果:67例患者中,23例出现流产或新生儿死亡,44例新生儿存活,手术成功率为65.67%。成功组术前宫口开大程度、术后最高C反应蛋白(CRP)均值和双胎、术前宫缩、宫口开大≥3 cm所占比例均小于失败组(P0.05,P0.01);而成功组手术孕周、延长孕周均值大于失败组(P0.01)。结论:紧急宫颈环扎术是宫颈机能不全宫口已经扩张的补救措施,但双胎妊娠、术前宫口扩大程度(尤其是扩大≥3 cm)、术前宫缩及感染是手术失败的影响因素。     

腹腔镜下宫颈环扎术治疗宫颈机能不全16例临床分析

目的探讨腹腔镜下宫颈环扎术治疗宫颈机能不全的效果和安全性。方法对2008年8月至2011年12月中山大学附属第一医院妇科16例经阴道宫颈环扎手术失败和无法行经阴道宫颈环扎术的宫颈机能不全患者,在非孕期行腹腔镜下宫颈环扎术,观察术后妊娠情况。结果 16例患者手术过程均顺利,无一例中转开腹。有10例患者妊娠,其中8例孕足月剖宫产,1例孕31周剖宫产分娩,1例妊娠20周时因胎膜早破导致难免流产,开腹手术剪断环扎带后经阴道娩出胎儿。行剖宫产患者平均分娩孕周为37.9周,较术前平均流产孕周平均延长17.9周。另6例患者中5例现术后1～3个月,尚未计划妊娠,1例术后1+年,未避孕未孕。结论腹腔镜下宫颈环扎术安全有效,可明显延长妊娠时间,增加活产率,可作为宫颈机能不全的治疗方法之一。     

宫颈机能不全47例分析

目的探讨宫颈环扎术治疗宫颈机能不全的价值。方法将我院1998年2月至2004年2月收治的宫颈机能不全的孕妇47例分为手术组(A组,29例)和非手术组(B组,18例),比较两组的胎儿存活率、平均延长孕周。结果胎儿存活率手术组91.7%,明显高于非手术组46.7%(P<0.01);平均延长孕周手术组14.4周,明显长于非手术组6.7周(P<0.01)。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,宫颈环扎术可以延长宫颈机能不全患者的孕周,提高胎儿存活率。     

经阴道紧急宫颈环扎术联合宫缩抑制剂对妊娠结局的影响

目的 探讨经阴道紧急宫颈环扎术联合宫缩抑制剂对妊娠结局的影响。方法 选取本院收治的60例宫颈机能不全孕妇为研究对象,随机分为两组,各30例。对照组实施宫缩抑制剂治疗,试验组实施经阴道紧急宫颈环扎术联合宫缩抑制剂治疗,比较两组的妊娠结局、新生儿基本情况及不良事件发生率。结果 试验组孕周延长时间、妊娠终止时间长于对照组,早产率低于对照组（P<0.05）;试验组新生儿体质量大于对照组,Apgar评分高于对照组,住院时间短于对照组（P<0.05）;试验组不良事件发生率为3.33%,低于对照组的23.33%(P<0.05)。结论 对宫颈机能不全孕妇实施经阴道紧急宫颈环扎术联合宫缩抑制剂治疗,疗效确切,可改善孕妇妊娠结局,降低不良事件发生风险。     

紧急宫颈环扎术的应用价值探讨

宫颈机能不全(cervical insufficiency)是造成反复中晚期流产及早产的主要原因之一。宫颈环扎术(cervical cerclage)是治疗宫颈机能不全的主要手术方式之一,其治疗效果一直是国内外学者的研究热点。而紧急宫颈环扎术是为了延长发育正常但未发育成熟的胎儿孕周而采取的急症手术,在单胎及多胎妊娠疗效、分娩方式及术式选择、并发症的处理、围手术期的处理和管理以及妊娠结局等方面仍存在争议。综述紧急宫颈环扎术治疗宫颈机能不全的应用价值,为临床提供治疗依据。     

宫颈组织结构与宫颈机能

宫颈是胎儿与阴道之间的屏障,是动态变化的组织结构,妊娠期宫颈内在组织成分发生一系列变化继而引起的解剖结构的变化,包括宫颈软化、成熟、延展,称为"宫颈重塑";宫颈组织结构先天发育异常或者宫颈手术可致妊娠中、晚期宫颈不能承受宫腔内压力,引起羊膜囊脱出,继而导致早产或中期流产。本文系统阐述宫颈在妊娠前、妊娠后及分娩后组织结构的一系列生理及病理学变化的研究进展。     

Cervical Insufficiency and Cervical Cerclage

ObjectiveThe purpose of this guideline is to provide a framework that clinicians can use to determine which women are at greatest risk of having cervical insufficiency and in which set of circumstances a cerclage is of potential value.EvidencePublished literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in 2012 using appropriate controlled vocabulary (e.g., uterine cervical incompetence) and key words (e.g., cervical insufficiency, cerclage, Shirodkar, cerclage, MacDonald, cerclage, abdominal, cervical length, mid-trimester pregnancy loss). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to January 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.ValuesThe quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table).     

Cervical Ripening

The purpose of this study was to evaluate the efficacy of adding laminaria tents to sequential intravaginal prostaglandin E₂ (PGE₂) gel for cervical ripening.

A prospective, randomized study was conducted from October 1994 to May 1995. Pregnant women with maternal or fetal indications for induction of labor at ≥37 weeks gestation and a Bishop score of ≤4 were eligible. Nineteen patients received laminaria tents in addition to 4 mg PGE₂ gel, while 25 patients received PGE₂ gel alone. After 4 hr, the laminaria tents were removed and the gel was continued in both groups at 4-hr intervals. Induction with oxytocin was initiated after a Bishop score of >5 was achieved.

The groups were comparable with respect to maternal age, parity, gestational age, reason for induction, and initial Bishop score. The addition of laminaria tents to sequential PGE₂ gel did not statistically improve the time to a favorable cervix (control group 12.7 ± 8.5 hr (95% CI, 9.1–16.3) and study group 10.9 ± 7.1 hr (95% CI, 7.5–14.3) (P = 0.59). The 6-hr difference from the time of the initial PGE₂ gel placement to delivery was not detected (control group 22.4 ± 11.2 hr, 95% CI 17–27 and study group 23.4 ± 13.1 hr, 95% CI 17–29.6 (P = 0.79). The combination approach of laminaria tents and PGE₂ gel did not have a significant impact on the vaginal delivery rate, with 28.0% of patients in the control group and 26.3% of patients in the study group undergoing cesarean section (P = 0.90). Maternal and neonatal complications were rare in both groups.

We had insufficient evidence to show that the addition of laminaria tents to PGE₂ gel improved cervical ripening, the induction to delivery interval, or the cesarean section rate in patients at term undergoing induction of labor.     

Cervical pregnancy

Summary Cervical pregnancy is one of the most dangerous forms of ectopic pregnancy. This condition is frequently unsuspected before evaluation of the uterus and it is characterized by massive bleeding during that procedure. We report a case of cervical ectopic pregnancy diagnosed by ultrasound at 11 weeks’ gestation and managed by emergency hysterectomy for severe hemorrhage occurring immediately after removal of the placenta.     

Efficacy of Hysteroscopic Cervical Resection for Cervical Stenosis

Study ObjectiveCervical stenosis can be an impediment to embryo transfer (ET) and intrauterine insemination (IUI). We propose a technique of hysteroscopic cervical resection to overcome cervical stenosis.DesignProspective clinical study (Canadian Task Force classification III).SettingPrivate general hospital.PatientsForty-three infertile women in whom trial ET or IUI had failed with 3 available catheters.InterventionsThe procedure was performed with a hysteroscope under ultrasound guidance. Starting from the external os, the loop electrode gradually resected protrusions and cervical tissue until the hysteroscope could enter the uterine cavity. Repeat trial ET/IUI was performed 1 month later. The women who became pregnant underwent sonographic measurement of the cervical length and dilatation in the second and third trimesters.Measurements and Main ResultsExcluding 13 patients in whom the sound could pass through the cervical canal after anesthesia, 30 patients were included for analysis. The procedure failed in 1 patient (3.3%). The mean operation time was 18.0 (±7.4) minutes. Repeat trial ET/IUI was successful in all patients. There were 5 twin pregnancies and 9 singleton pregnancies after IUI or ET. From the 5 women with twin pregnancies; 2 underwent premature delivery at 34 weeks; and 3 underwent elective cesarean delivery at 35, 36, and 37 weeks, respectively. From the 9 women with singleton pregnancies, 1 underwent cesarean section at 36 weeks because of preeclampsia, and the other 8 delivered at term.ConclusionHysteroscopic cervical resection is a safe and effective treatment for cervical stenosis.