安宝用于治疗宫颈机能不全行宫颈环扎术后保胎效果观察

目的:探讨宫颈环扎术后安宝保胎治疗效果。方法:25例因宫颈机能不全行宫颈环扎术后患者行安宝保胎治疗。结果:25例中23例维持至足月分娩,1例19周流产、1例孕32周早产。新生儿存活24例(96%)。结论:宫颈环扎术后应用安宝保胎治疗可使妊娠维持至足月或接近足月,提高新生儿存活率,对优生及孕产妇身心健康有重要意义。     

紧急宫颈环扎术治疗宫颈机能不全致晚期流产和早产的临床应用价值

目的:探讨紧急宫颈环扎术在宫颈机能不全所致晚期流产和早产中的临床应用价值。方法:回顾性分析2013年3月至2015年10月我院收治18例行紧急宫颈环扎术患者的临床资料。结果:18例行紧急宫颈环扎术患者延长孕龄4~146天,11例早产,2例足月分娩,5例流产,共得到存活新生儿15例。宫颈口扩张2~6 cm组与2 cm组新生儿出生体质量、Apgar评分比较差异无统计学意义(P0.05),6 cm组的新生儿出生体质量、Apgar评分与2~6 cm组、2 cm组比较差异均有统计学意义(P0.05)。结论:紧急宫颈环扎术可有效延长孕周,改善妊娠结局,提高新生儿存活率,是宫颈机能不全患者宫颈口扩张、胎膜突出时的有效治疗手段,对于宫颈口扩张6 cm的效果更好。     

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。     

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。     

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。     

宫颈环扎术在早产治疗中的应用

目的评估治疗性宫颈环扎术及预防性宫颈环扎术的效果。方法选择2003年1月至2006年3月北京大学第三医院的34周前的早产临产及宫颈机能不全患者,早产临产患者采取紧急宫颈环扎术联合宫缩抑制剂或者单纯使用宫缩抑制剂治疗。宫颈机能不全患者采取预防性宫颈环扎术、紧急环扎术以及非环扎保守治疗。对治疗结局进行统计学分析。结果在早产临产组,紧急宫颈环扎联合宫缩抑制剂（硫酸镁）来治疗早产,平均保胎天数45.00 d,较单纯用宫缩抑制剂硫酸镁抑制宫缩的34例患者保胎天数[中位数为1（0.75-16）d]明显延长,34、37周后分娩率分别为66.7%（26/39）、30.8%（12/39）,明显增加。宫颈机能不全患者预防性环扎及治疗性环扎均较非环扎组保胎天数延长,增加32、34周后的分娩率（P〈0.05）,但治疗性环扎可降低早产率（P=0.02）。结论观察资料结果显示早产临产患者硫酸镁联合宫颈环扎治疗早产效果更佳,增加34周以上的分娩率,降低早产率;预防性环扎不能降低37周前早产率,但能增加32、34周后分娩率,延长保胎天数;治疗性环扎可降低37周前早产率。     

孕期经阴道宫颈环扎术治疗宫颈机能不全

宫颈机能不全是导致反复晚期流产和早产的主要原因之一。孕期行宫颈环扎术是治疗宫颈机能不全的最有效方法,它能明显延长孕周、提高妊娠成功率,改善围产结局。本文就孕期宫颈机能不全的诊断以及行宫颈环扎术的方法、疗效、手术并发症等进行讨论。     

预防性与紧急性宫颈环扎术治疗宫颈功能不全的效果分析

目的 分析预防性与紧急性宫颈环扎术治疗宫颈功能不全的效果。方法 选取本院74例宫颈功能不全的孕妇为研究对象,随机数字表法将其分为两组,各37例。对照组采用紧急性宫颈环扎术,观察组采用预防性宫颈环扎术。对比两组手术相关指标、分娩情况、并发症发生率及妊娠结局。结果 观察组术中出血量、住院时间小于对照组,妊娠延长时间、分娩孕周及妊娠32周宫颈长度大于对照组（P<0.05）;观察组并发症发生率低于对照组,足月产率和新生儿存活率高于对照组（P<0.05）。结论 预防性宫颈环扎术治疗孕妇宫颈功能不全,效果显著,能减少出血量,缩短住院时间,延长产妇妊娠时间和分娩孕周,并发症发生率低,妊娠结局好,值得临床推广。     

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...     

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。     

孕期不同指征经阴道宫颈环扎术的效果评价

目的:回顾性分析孕期3种不同指征经阴道宫颈环扎术的妊娠结局和新生儿预后。方法:收集66例采用Mc Donald方法进行宫颈环扎术患者的临床资料。结果:病史指征性环扎组与超声指征性环扎组,在平均分娩孕周、活产率及新生儿平均出生体质量方面差异均无统计学意义(P0.05)。紧急性环扎组的分娩孕周(29.17±6.44)周均低于病史指征性环扎组的(34.06±6.66)周和超声指征性环扎组的(35.42±4.75)周,差异有统计学意义(P0.05)。紧急环扎组中手术失败孕妇在宫口开大程度、术后白细胞计数及C反应蛋白(CRP)最高值较手术成功孕妇高。结论:病史指征性环扎术和超声指征性环扎术均可获得良好的相似妊娠结局。术后加强抗炎可提高紧急性环扎手术的成功率。剖宫产再孕者有一定的发生宫颈机能不全的概率,孕期应B超监测宫颈的变化。     

The effect of second trimester emergency cervical cerclage on perinatal outcome

Objective: To evaluate the effectiveness of emergency cervical cerclage and to determine predictors of failure or success in women with cervical incompetence. Methods: Medical records were reviewed for clinical and demographic data, gestational age at time of cerclage, cerclage–delivery interval, gestational age at time of delivery; and birth weight. Predictors of success and failure were analyzed. Result: Forty-three pregnant women between 18 and 25 weeks of gestation were recruited. The mean gestational age at time of cerclage was 21 weeks. The mean cerclage–delivery interval was 64 days. The mean gestation at delivery was 31 weeks and the mean neonatal birth weight was 2166 g. Whether cerclage done before or after 20 weeks, the difference in cerclage–delivery interval was insignificant while the difference in gestational age at time of delivery and neonatal birth weight was significant. Presence of infection, presence of symptoms, membranes through the cervix and dilated cervix >3 cm are frequently associated with failure. Conclusion: Emergency cervical cerclage is effective in prolonging pregnancy and improving neonatal outcome in patient with cervical incompetence. However, large prospective randomized controlled studies are recommended.     

Obstetrical outcomes of emergency compared with elective cervical cerclage

Objective: To study obstetric outcomes of emergency cerclage compared with elective cerclage.

Study design: Retrospective cohort study of pregnancy outcomes of patients who underwent cervical cerclage, performed according to ACOG guidelines, between January 2006 and December 2014. Patients who underwent emergency cerclage, due to cervical shortening or cervical dilation (emergency cerclage group) were compared with patients who underwent history-indicated cerclage (elective cerclage group). Emergency cerclage was not performed in patients with uterine contractions, vaginal bleeding, or signs of chorioamnionitis. Procedure-related complications were defined as rupture of membranes or chorioamnionitis occurring after cerclage placement and before 24 weeks of gestation.

Results: Overall, 154 patients with elective cerclage and 47 patients with emergency cerclage were included. Mean gestational age at cerclage operation was 13.1?±?1 and 20.2?±?3 weeks, respectively. There were no differences between the emergency cerclage group and the elective cerclage group regarding mean gestational age at delivery (36.1?±?3 versus 35.6?±?3, respectively, p?=?0.7), rate of deliveries beyond 34 weeks of gestation (81.81% versus 78.72%, respectively, p?=?0.67), rate of deliveries beyond 37 weeks of gestation (64.93% versus 59.57%, respectively, p?=?0.6), cesarean deliveries (33.11% versus 39.13%, p?=?0.48, respectively), or birthweight (2848 versus 2862 grams, respectively, p?=?0.9). Regarding procedure-related complications, there were no differences between the elective and the emergency cerclage groups in the rate of chorioamnionitis (1.29% versus 4.34%, respectively, p?=?0.22), or ruptured membranes (1.29% versus 4.34%, respectively, p?=?0.22).

Conclusion: Pregnancy outcomes of emergency cerclage are comparable with those of elective cerclage.     

Effectiveness of emergency cerclage in cervical insufficiency

Objective: To assess the effectiveness of emergency cerclage versus conservative management in improving obstetric and neonatal outcomes in women with clinically evident cervical insufficiency.

Methods: Retrospective cohort study conducted on all women with a single viable pregnancy diagnosed with cervical insufficiency between the 14th and 24th gestational week without pPROM, clinical chorioamnionitis, vaginal bleeding, treatment-resistant uterine contractions or life-incompatible fetal anomalies, from January 2009 to December 2014. Obstetric and neonatal outcomes were compared between women who underwent cerclage and those who refused, preferring a conservative therapy.

Results: Eighteen women underwent emergency cerclage and 19 were managed with a conservative therapy. Mean gestational age at delivery, time from diagnosis to delivery and rate of term birth were significantly higher in the first cohort. Those variables show a linear inverse correlation with the degree of cervical dilatation, with better outcomes in patients who underwent cerclage with a dilatation lower than 5.0 cm. No difference in mode of delivery were found.

Conclusion: Emergency cerclage is a valid therapeutic option between the 14th and 24th gestational week in presence of cervical insufficiency when signs of premature labour or infection are not present, with lower expectations with a dilatation greater than 5 cm.     

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。     

子宫颈缩短的双胎输血综合征患者胎儿镜术中同时行子宫颈环扎术对妊娠结局的影响

目的 探讨胎儿镜术中同时行子宫颈环扎术对于治疗子宫颈长度缩短的双胎输血综合征(TTTS)患者妊娠结局的影响.方法 采用回顾性研究,将2016年6月至2018年12月中国医科大学附属盛京医院收治的61例子宫颈长度≤20mm并接受胎儿镜激光手术(FLS)治疗的TTTS患者作为研究对象,将研究对象分为两组:环扎组(n=38)...     

Emergency cervical cerclage using a metreurynter in patients with bulging membranes.

Emergency cervical cerclage was performed in 26 women between 18 and 32 weeks of gestation who had fetal membranes bulging through a widely dilated cervix. A bulging bag was pushed into the uterine cavity by a new method, using a metreurynter. The average prolongation of pregnancy after the operation in the 26 women was 41 days (ranging from 2 to 115 days). All pregnancies resulted in the live birth of altogether 28 babies. The neonatal survival rates at gestational ages of less than or equal to 26 (including two sets of twins), 27-29, and greater than or equal to 30 weeks at the time of cervical cerclage were 80.0 (12/15), 85.7 (6/7), and 100% (6/6), respectively. Ten (83.3%) of the 12 infants who survived from patients receiving cerclage at a gestational age of less than or equal to 26 weeks are alive and well. The average duration of pregnancy after cerclage was 60 days when cervical dilation was less than or equal to 5 cm at operation, in contrast to 5.4 days in patients with cervical dilation of greater than or equal to 6 cm, suggesting that emergency cervical cerclage could be suitable in the presence of a cervical dilation of 5 cm or less.     

Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence

OBJECTIVE: The aim of the present study was to compare the outcome of pregnancies among patients with suspected cervical incompetence treated either by elective cervical cerclage or an alternative management program involving cervical surveillance. DESIGN, SETTING AND METHODS: A prospective cohort study was performed in two groups of patients at risk of cervical incompetence with singleton gestations attending the Royal Women's Hospital, Melbourne, Australia, from 1996 to 2000. The first group was managed by their obstetric carers with an elective cerclage, while the second group was managed conservatively as part of a cervical surveillance program offered to patients attending the Department of Perinatal Medicine for pregnancy care. This program consists of weekly visits from 16 weeks' gestation and involves alternating transvaginal ultrasound assessment of cervical morphometry with cervico-vaginal bacteriology and fetal fibronectin swabs. Empiric insertion of a cerclage is undertaken when there is evidence of significant cervical shortening (cervical canal <2.5 cm in length at 相似文献   

Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone

OBJECTIVE: The purpose of this study was to compare preterm delivery rates and neonatal morbidity/mortality rates for women with cervical incompetence with membranes at or beyond a dilated external cervical os that was treated with emergency cerclage, bed rest plus indomethacin, versus just bed rest. STUDY DESIGN: Women with cervical incompetence with membranes at or beyond a dilated external cervical os, before 27 weeks of gestation, were treated with antibiotics and bed rest and randomly assigned for emergency cerclage and indomethacin or bed rest only. RESULTS: Twenty-three women were included; 13 women were allocated randomly to the emergency cerclage and indomethacin group, and 10 women were allocated randomly to the bed rest-only group. Gestational age at time of randomization was 22.2 weeks in the emergency cerclage and indomethacin group and 23.0 weeks in the bed rest-only group. Mean interval from randomization until delivery was 54 days in the emergency cerclage and indomethacin group and 20 days in the bed rest-only group (P=.046). Mean gestational age at delivery was 29.9 weeks in the emergency cerclage and indomethacin group and 25.9 weeks in the bed rest-only group. Preterm delivery before 34 weeks of gestation was significantly lower in the emergency cerclage and indomethacin group, with 7 of 13 deliveries versus all 10 deliveries in the bed rest-only group (P=.02). CONCLUSIONS: Emergency cerclage, indomethacin, antibiotics, and bed rest reduce preterm delivery before 34 weeks compared with bed rest and antibiotics alone.