经阴道超声诊断宫颈机能不全探讨

目的探讨经阴道超声检查对宫颈机能不全患者的诊断价值。方法回顾性分析30例宫颈不全患者(宫颈机能不全组),分析于非孕期经阴道超声测量宫颈总长度、宫颈阴道段长度、宫颈内口宽度,并随访分析孕16周的经阴道超声检查结果,并与30名健康体检者(健康对照组)进行对照。结果宫颈机能不全组患者非孕期宫颈总长度为(34.10±4.42)mm,宫颈阴道段长度为(16.33±2.34)mm,健康对照组的分别为(43.19±2.48)mm和(24.33±3.12)mm,两者比较差异有统计学意义(t=6.78、6.24,P均<0.01),孕16周经阴道超声测量宫颈总长度为(32.46±4.25)mm,宫颈阴道段长度为(15.38±3.62)mm,与健康对照组比较,差异有统计学意义(t=8.36、7.88,P均<0.05)。宫颈阴道段与宫颈总长度的比值与晚期自然流产次数存在显著相关性(r=0.55,P<0.05)。以宫颈阴道段长度≤19mm为最佳临界点,经阴道超声诊断宫颈机能不全的敏感度、特异度、阳性似然比、阴性似然比及正确指数分别为90.00%、90.00%、9.00、0.11、80.00。结论经阴道超声检测宫颈对判断非孕期宫颈机能不全患者具有一定价值。     

经阴道超声检查早期诊断宫颈机能不全的价值

宫颈机能不全(cervicalincompetence,CIC)的早期诊断一直是临床产科急需解决的问题。近年来,随着腔内超声在产科的应用,CIC的早期诊断成为可能。我们应用经阴道对108例无症状的习惯性早产、流产的孕妇于中孕时进行检查,并与经腹部超声检查进行对照,对结果进行分析,以评价经阴道超声在早期诊断CIC中的价值。1资料和方法1.1研究对象1999年3月～2003年10月就诊的无症状的习惯性早产或流产的孕妇108名,平均年龄28.5岁,早产或流产3次以上,最多5次。孕龄16～20周58例,21～24周50例,平均孕龄20.5周。先后应用经阴道和经腹部超声检查观察宫颈情…     

研究孕期经阴道宫颈环扎术治疗宫颈机能不全

目的:研究孕期经阴道宫颈环扎术治疗宫颈机能不全的临床疗效。方法:选择本院在2018年4月至2019年4月收治的50例宫颈机能不全患者进行临床研究,针对这些患者均使用经阴道宫颈环扎术进行治疗,观察患者临床效果,主要包括阴道分娩、剖宫产、早产、死亡、手术成功、胎儿成活等方面。结果:50例患者手术成功率为96.00%,胎儿存活率为90.00%。结论:患者妊娠是否能够成功,与宫颈长度存在紧密联系。当妇女怀孕13~18周之后,对于宫颈机能不全的患者,为其实施宫颈环扎术进行治疗,能够有效帮助患者延长孕周,并且能够进一步增加胎儿的存活率。     

超声评估非孕期宫颈机能不全研究进展

宫颈在妊娠和分娩中发挥关键作用，宫颈机能不全（CIC）可导致女性出现反复流产及早产。孕前评估宫颈机能是可使备孕女性避免不良妊娠结局的重要保障，超声则是评估宫颈机能不全的常用方法。本文对超声评估非孕期宫颈机能不全研究进展进行综述。     

经腹及经阴道彩超辅助临床诊断宫颈机能不全孕妇的价值对比

目的:对比分析经腹部彩超和经阴道彩超辅助临床诊断宫颈机能不全孕妇的价值。方法:将我院2020年11月至2021年11月收治的50例疑似宫颈机能不全孕妇纳为本次研究对象,50例孕妇均先行问诊、妇科检查和超声检查,再行经腹部超声检查(经腹组)和经阴道超声检查(经阴道组),对比分析两组的诊断价值。结果:经阴道组宫颈内口显示率、宫颈外口显示率、羊膜囊嵌入宫颈内程度显示率均高于经腹组(P<0.05)。两组宫颈长度<2cm、宫颈管内径>6mm、宫颈内有羊膜囊嵌入影像的检出率差异有统计学意义(P<0.05)。50例孕妇经综合判断为宫颈机能不全者有37例,经阴道彩超检查诊断宫颈机能不全的灵敏度、特异度、准确率、阳性预测值、阴性预测值均较高。结论:经阴道彩超检查诊断宫颈机能不全孕妇,与经腹部彩超相比,宫颈内口、宫颈外口以及羊膜囊嵌入宫颈内程度显示率与检出率更高,诊断价值也更高。     

经会阴超声测量中孕期宫颈管长度在预测早产中的临床应用

目的:探讨经会阴超声测量中孕期宫颈管长度在预测早产中的临床应用效果。方法:选取在妊娠中期(孕24周)至我院检查的初产单胎妊娠孕妇70例,进行经会阴超声检查,以测量记录宫颈管长度,并对其妊娠结局进行追踪,根据是否发生早产,将其分为早产组和非早产组,对比分析2组孕24周、28周、32周的宫颈管长度。结果:宫颈管30mm的患者,早产率高于宫颈长度30mm的患者,而早产组的宫颈管长度均短于非早产组(P0.05)。结论:经会阴超声测量中孕期宫颈管长度可准确预测早产的发生,具有临床推广价值。     

超声监测妊娠期宫颈成熟度的临床价值

目的　应用超声显像监测妊娠期宫颈成熟度 ,探讨其在妊娠期的变化规律。方法　经腹部、会阴及阴道超声检查观察妊娠期宫颈 117例 ,比较其成功率及准确性。结果　阴道超声显像成功率达 10 0 % ,显著高于会阴及腹部超声 ,宫颈长度测值则较腹部及会阴短 (P <0 .0 1)。正常妊娠期 ,阴道超声宫颈长度测值 :中孕期 ( 33.6± 3.6mm) ;晚孕期 ( 32 .1± 4.2mm) ;足月未临产者 ( 2 6.3± 4.9mm)。结论　阴道超声宫颈显像成功率及准确性高于腹部、会阴超声 ;宫颈管长度在孕 2 8～ 37周相对恒定 ,孕 38周后逐渐缩短 ,其长度与临产时间十分相关     

宫颈机能不全7例的超声诊断

目的 探讨超声检查对宫颈机能不全的诊断价值。方法 对经超声及手术证实的7例宫颈机能不全患者的资料作回顾性分析,7例患者均进行经腹部及经会阴超声检查宫颈管情况。结果 7例患者均符合宫颈机能不全诊断标准。宫颈内口呈“Y”形者2例,功能性宫颈长度20~25mm,宫颈漏斗比例均为27%;呈“V”形者1例,功能性宫颈长度11mm,宫颈漏斗比例为66%;呈“U”形者4例,功能性宫颈长度均<10 mm,宫颈漏斗比例为72%~83%。7例孕妇均行宫颈环扎术至足月分娩,无一例早产。结论 超声测量宫颈长度对宫颈机能不全的诊断准确性高,实用性强,且简便、直观、易行、可重复性强。 更多还原     

超声在评估非孕期宫颈机能不全的临床研究进展

宫颈在女性妊娠和分娩过程中有重要作用,而宫颈机能不全(CIC)是导致女性出现反复流产和早产的独立危险因素。因此,在女性孕前对其宫颈功能进行评价,可以有效预防不良妊娠事件发生。超声作为临床妇产科常用影像学技术,不仅操作简单,且有较高安全性,理想的成像技术和清晰的成像优势,也间接性扩大了技术的可用范围,用于评估女性宫颈机能情况和诊断CIC有一定应用价值。基于此,本文分析宫颈结构及功能,阐述CIC相关发病机制,并就近年来有关非孕期CIC使用超声评估的方法进行总结,如下所示。     

经会阴与经腹部超声检查在宫颈机能不全诊断中的应用观察

目的:研究比较经会阴超声与经腹部超声检查在宫颈机能不全诊断中的应用价值。方法:选择我院就诊的70例疑似宫颈机能不全患者(2017年1月～2018年6月),采用彩色多普勒超声检测仪,对患者实施经腹部超声检查、经会阴超声检查,以宫腔镜诊断结果为参照,计算和比较经腹部超声、经会阴超声对宫颈机能不全的诊断灵敏度、特异度、准确率,并分析两种超声诊断结果与宫腔镜诊断结果之间的一致性。结果:70例疑似宫颈机能不全患者中,有52例患者经宫腔镜诊断为宫颈机能不全,以宫腔镜诊断结果为参照,经会阴超声对宫颈机能不全的诊断灵敏度、特异度、准确率均高于经腹部超声(P0.05)。一致性分析结果显示,经会阴超声检查结果与宫腔镜诊断结果之间的一致性良好,优于经腹部超声。结论:在宫颈机能不全诊断中,采用经会阴超声检查的诊断准确性优于经腹部超声检查,可推广应用于宫颈机能不全诊治中。     

Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies?

OBJECTIVE: To determine whether high-risk patients manifest cervical length < 25 mm on transvaginal ultrasound before 14 weeks of gestation, and if this finding is predictive of preterm delivery. METHODS: Asymptomatic pregnancies at high risk for preterm birth were followed prospectively from 10 + 0 weeks to 13 + 6 weeks with transvaginal sonographic measurement of the cervix. A cervical length < 25 mm was considered a short cervix at this gestational age and at the follow-up ultrasound examinations, performed between 14 and 24 weeks. The primary outcome was preterm birth at < 35 weeks of gestation. RESULTS: One hundred and eighty-three pregnancies met the study criteria and were included in the analysis. Only 10 (5%) patients had a cervix < 25 mm before 14 weeks. The sensitivity, specificity and positive and negative predictive values of a short cervix were 14%, 97%, 50%, and 82%, respectively (relative risk, 2.8; 95% confidence interval, 1.4-5.6). The mean transvaginal sonographic cervical length before 14 weeks of gestation was 33.7 +/- 6.9 mm in pregnancies which delivered preterm (n = 36), and 35.0 +/- 6.8 mm in those delivering at term (n = 147) (P = 0.3). Follow-up transvaginal ultrasound examination of the cervix to 24 weeks revealed that the average gestational age at which a short cervix was detected was 18.7 +/- 2.9 weeks. CONCLUSION: A cervical length < 25 mm on transvaginal sonographic assessment rarely occurs before 14 weeks even in high-risk patients destined to deliver preterm; in these patients cervical changes predictive of preterm birth develop mostly after this gestational age.     

超声弹性成像组织弥散定量分析技术预测宫颈功能不全

目的 评价超声弹性成像组织弥散定量分析技术预测宫颈功能不全（CIC）的价值。方法 收集临床诊断为CIC的18例患者（CIC组）和正常女性20名（对照组）,于非孕期行经阴道超声检查,测量宫颈长度和厚度,采用超声弹性成像组织弥散定量分析技术获得11个宫颈弹性特征量值,包括应变均值、标准偏差、蓝色区域所占百分比（% AREA）、复杂度、偏度、峰度、对比度、均等性、杂乱度、一致性及相关性,比较2组间的差异,绘制ROC曲线获得对CIC有诊断价值的指标。结果 2组间弹性特征量应变均值、标准偏差、% AREA、复杂度、偏度、对比度、均等性、一致性差异均有统计学意义（P均<0.05）,而宫颈长度、厚度和峰度、杂乱度、相关性差异均无统计学意义（P均>0.05）。ROC曲线分析结果显示,% AERA、复杂度和均等性对CIC具有诊断价值（AUC=0.83、0.82、0.71）,其临界值分别为% AERA=34.85、复杂度=20.84、均等性=3.20,其中% AREA敏感度最高（94.74%）,复杂度特异度最高（73.08%）。结论 超声弹性成像组织弥散定量分析技术预测CIC具有一定价值。     

经阴道超声监测孕妇宫颈形态预测早产的价值

目的评价经阴道超声监测宫颈形态变化对早产的预测价值。方法 223例孕妇分为足月分娩组134例和先兆早产组89例,分别于孕24、28、32及36周行经阴道超声检查,观察宫颈形态长度的变化,以及宫颈指数,并对其妊娠结局进行随访。结果足月分娩组中宫颈长度随孕周增大而缩短;先兆早产组孕妇的宫颈长度均较相应孕周的足月分娩组短,其中24、28及36周组间比较,差异有统计学意义(P<0.05)。先兆早产组各孕周的宫颈指数均较足月分娩组大,两组比较差异有统计学意义(P<0.05)。89例先兆早产组中71例保胎成功,18例发生早产。先兆早产组中21例有宫颈漏斗形成,18例早产者均有宫颈漏斗形成。漏斗形成预测早产的敏感性为100%、特异性为96.6%;以足月分娩孕妇28周时的宫颈长度2.61cm为临界值,其预测早产的敏感性为83.3%、特异性为100%。结论经阴道超声实时监测宫颈形态结构变化对预测早产的发生有一定的临床价值。     

Patterns of normal change in cervical length and width during pregnancy in nulliparous women: a prospective, longitudinal ultrasound study.

OBJECTIVES: To determine what constitutes normal changes in the uterine cervix visible at transvaginal ultrasound examination from 24 gestational weeks until delivery in nulliparous women delivering at term. DESIGN: Cervical length and width were measured using transvaginal ultrasound, and the inner cervical os was assessed as being closed or open every 2 weeks from gestational week 24 until delivery in 19 healthy nulliparae delivering at term. RESULTS: In all but one woman cervical length decreased, and in all but one woman cervical width increased, with advancing gestation. Three patterns of change in cervical length were observed: a continuous decrease ( n = 10), an accelerated shortening rate after approximately 30 gestational weeks ( n = 5), or a sudden drop in length between the last two examinations ( n = 3). The median rate of decrease in cervical length was 1 (range, 0.6-1.9) mm/week for women with continuous shortening of the cervix. For women with accelerated shortening the corresponding figure was 2.2 (range, 1.8-2.7) mm/week after the start of accelerated shortening. Two patterns of increase in cervical width (cervical broadening) were noted: a continuous increase ( n = 12), or an accelerated broadening rate from around 32 weeks ( n = 6). The median rate of increase in cervical width was 0.8 (range, 0.3-2.0) mm/week for women with continuous broadening of the cervix. For women with accelerated broadening rate the corresponding figure was 1.7 (range, 1.0-6.4) mm/week after the start of increased broadening rate. Opening of the internal cervical os was observed at least once in eight of the 19 women (42%) and was first observed at 30 gestational weeks. Dynamic changes (i.e. opening and closing of the inner cervical os during examination) were seen in six women (32%) and were first detected at 31 gestational weeks. CONCLUSIONS: There are different patterns of normal change in cervical length and width during pregnancy in nulliparous women. This must be taken into account if repeated ultrasound examinations of the cervix during pregnancy are used to identify nulliparae at increased risk of preterm delivery.     

Transvaginal sonographic examination of the cervix in asymptomatic pregnant women: review of the literature.

Different strategies have been developed to refine the prediction of the risk of preterm delivery in asymptomatic patients. Transvaginal sonography has been used for this reason to measure and examine the length and shape of the cervix. In this review, we focus on clinical studies involving transvaginal sonographic assessment of the cervix in asymptomatic women at high risk of preterm delivery and in the general pregnant population. Three ultrasound signs are suggestive of cervical incompetence, namely, dilatation of the internal os, sacculation or prolapse of the membranes into the cervix (with shortening of the functional cervical length) either spontaneously or induced by transfundal pressure, and short cervix in the absence of uterine contractions. Transvaginal sonography has clearly demonstrated that cerclage leads to a measurable increase in cervical length which may contribute to the success of this procedure in reducing the risk of preterm delivery. Several non-randomized interventional studies among patients with cervical incompetence have been published. They have defined a new group of patients requiring cerclage when the women show progressive cervical modifications on transvaginal sonography, while in other studies, cerclage performed on the basis of cervical changes on transvaginal sonography did not prevent premature delivery. One prospective randomized trial in asymptomatic high-risk women has shown two benefits of cerclage following indications for transvaginal sonography: (1) it would generate fewer prophylactic cerclages in high-risk women; (2) therapeutic cerclage before 27 weeks may reduce the incidence of premature delivery before 34 weeks. The risk of preterm delivery is inversely correlated with cervical length. Routine transvaginal sonography of the cervix performed between 18 and 22 weeks can help identify patients at risk of preterm delivery. However, given the low prevalence of preterm births, screening would generate either a high false-positive rate or a low sensitivity. One non-randomized interventional study among patients with a short cervix on routine ultrasound examination found a lower risk of delivery before 32 weeks in the cerclage group than in the expectant management group. However, to date, there have been no prospective randomized trials in a general population. Although evidence is still lacking, there does appear to be a benefit in performing a cerclage rather than continuing with expectant management in cases with sonographic appearance of cervical incompetence in asymptomatic women at high risk of preterm delivery. Ultrasound can be offered to reduce the indications of cerclage for cases in which the situation is uncertain. Within the general obstetric population, transvaginal sonography might help in the selection of asymptomatic but high-risk women. However, the benefit associated with cerclage for sonographic indication has not been demonstrated.     

Reference data representative of normal findings at two-dimensional and three-dimensional gray-scale ultrasound examination of the cervix from 17 to 41 weeks' gestation.

OBJECTIVES: To create reference values representative of normal findings on two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVS) examination of the cervix from 17 to 41 weeks' gestation and to determine the agreement between cervical measurements taken by 2D and 3D TVS. METHODS: Cross-sectional study covering 17 to 41 weeks in 419 nulliparous and 360 parous women who delivered at term and who underwent 2D and 3D TVS examination of the uterine cervix. We examined approximately 25 women in each gestational week. The length, anteroposterior (AP) diameter and width of the cervix (and of any cervical funnel) and AP diameter of the cervical canal were measured. Results were plotted against gestational age. The agreement between 2D and 3D ultrasound results was expressed as the mean (+/- 2 SDs) difference between the results of the two methods and as the interclass correlation coefficient (inter-CC). RESULTS: There was excellent agreement between measurements taken by 2D and 3D ultrasound (inter-CC values, 0.80-0.98) but measurements of cervical length taken using 3D ultrasound were greater than measurements taken by 2D ultrasound (mean difference, -0.04 +/- 0.36 cm). Cervical length did not change substantially between 17 and 32 gestational weeks but decreased progressively thereafter. Cervical length was similar in nulliparous and parous women at 17-32 weeks, but from 33 weeks the cervix tended to be longer in parous women. In nulliparae, cervical length decreased from a median of 3.8 (range, 0.7-6.1) cm at 17-32 weeks to 2.3 (range, 0.4-6.0) cm at 33-40 weeks and to 0.7 (range, 0.2-1.5) cm at 41 weeks. In parous women, the corresponding figures were 3.9 (range, 1.0-6.1) cm, 3.0 (range, 0.4-5.7) cm and 0.8 (range, 0.4-3.4) cm (results obtained by 3D ultrasound). Cervical AP diameter and width did not differ between nulliparous and parous women. Median AP diameter increased from 3.0 (range, 2.0-4.6) cm at 17-30 weeks to 3.5 (range, 1.8-5.5) cm at 31-40 weeks and to 4.0 (range, 2.8-5.9) cm at 41 weeks. Cervical width was 3.7 (range, 2.3-6.0) cm at 17-30 weeks and 4.5 (range, 2.3-6.1) cm at 31-41 weeks. The percentage of women with funneling increased from 4% (3/84) at 17-18 weeks to 63% (12/19) at 41 weeks and the percentage of women with an open cervical canal increased from 19% (15/84) to 72% (13/19). Funneling and opening of the cervical canal were equally common in nulliparous and parous women. CONCLUSIONS: Reference data provide the basis for studies of pathological conditions. Common reference values for nulliparous and parous women can be used for cervical AP diameter and width from 17 to 41 weeks and for cervical length from 17 to 32 weeks. Separate reference values for cervical length for nulliparous and parous women should be used from 33 to 41 weeks.     

HPV16／18、survivin与宫颈癌进展关系的相关性及临床意义

【目的】探讨HPV16／18和survivin在宫颈癌进展中的相关性及临床意义。【方法】选择高危宫颈癌患者108例做常规宫颈脱落细胞和分泌物PCR-HPV-DNA检查,并在阴道镜下行宫颈多点活检做病检和免疫组化,比较不同分级HPV感染阳性率和survivin蛋白表达阳性率,分析HPV-DNA基因表达与sur-vivin蛋白表达的相关性。【结果】宫颈上皮内瘤样病变Ⅰ级（CINⅠ）、CINⅡ、CINⅢ级和宫颈癌患者的宫颈HPV16／18感染阳性率分别为42．42％、61．90％、68．42％和82．86％,显著高于正常体检者的15．00％,其差异有统计学意义（P＜0．05）;CINⅠ、CINⅡ、CINⅢ级和宫颈癌患者的宫颈survivin蛋白表达阳性率分别为81．82％、90．48％、100％和100％,显著高于正常体检者阳性率的10．0。％,其差异均有统计学意义（P〈0．05）;CINⅠ、CINⅡ、CINⅢ级和宫颈癌患者的HPVl6／18-DNA基因表达与survivin蛋白表达存在正相关（P〈0．05）。【结论】HPVl6／18和survivin与宫颈癌进展关系密切,且均随CIN分级和宫颈癌级别的升高而表达增加,两者联合检测有利于提高宫颈癌的诊断率。     

The cervix as a predictor of preterm delivery in 'at-risk' women.

OBJECTIVE: To examine the relationship between ultrasound-determined cervical status and pregnancy outcome in women 'at-risk' of spontaneous preterm delivery. DESIGN: A prospective cohort study of 120 pregnant women considered to be 'at-risk' of spontaneous preterm delivery by their clinician. Transvaginal ultrasound of the cervix was used to assess overall cervical length, closed endocervical canal length, diameter and internal os dilatation in the second trimester. The main outcome measure was occurrence of spontaneous preterm birth (< 34 and < 37 weeks of gestation). RESULTS: The overall preterm delivery rate (< 37 weeks gestation) in these women was 35% (n = 42) with 20% (n = 24) delivering < 34 weeks gestation. Of the 71 women with a normal cervix, 8 (11%) delivered < 34 weeks, whereas of the 49 women with an abnormal cervix, 16 (33%) delivered < 34 weeks (RR 2.90; 95% CI 1.35-6.24). Using linear regression, closed endocervical canal length of < 21 mm before 20 weeks is associated with delivery < 34 weeks in 95% of women, and with delivery < 37 weeks in 95% of women if the canal length is < 33 mm. Logistic regression showed closed endocervical canal length to be the only significant factor in those women who delivered < 34 weeks after controlling for possible confounders. CONCLUSIONS: A strong relationship is demonstrated between cervical status and pregnancy outcome, particularly the cervical findings before 20 and 24 weeks of gestation. The length of the closed portion of the endocervical canal is the best predictor. A beneficial effect of this approach to 'at-risk' women is the reduction in unnecessary interventions in those with normal cervical findings.