Abstract：
Most deliveries before 34 weeks of gestation occur in individuals with no previous history of preterm birth. Midtrimester cervical length assessment using transvaginal ultrasound is one of the best clinical predictors of spontaneous preterm birth. This Consult provides guidance for the diagnosis and management of a short cervix in an individual without a history of preterm birth. The following are Society for Maternal-Fetal Medicine recommendations: (1) we recommend that all cervical length measurements used to guide therapeutic recommendations be performed using a transvaginal approach and in accordance with standardized procedures as described by organizations such as the Perinatal Quality Foundation or the Fetal Medicine Foundation (GRADE 1C); (2) we recommend using a midtrimester cervical length of ≤25 mm to diagnose a short cervix in individuals with a singleton gestation and no previous history of spontaneous preterm birth (GRADE 1C); (3) we recommend that asymptomatic individuals with a singleton gestation and a transvaginal cervical length of ≤20 mm diagnosed before 24 weeks of gestation be prescribed vaginal progesterone to reduce the risk of preterm birth (GRADE 1A); (4) we recommend that treatment with vaginal progesterone be considered at a cervical length of 21 to 25 mm based on shared decision-making (GRADE 1B); (5) we recommend that 17-alpha hydroxyprogesterone caproate, including compounded formulations, not be prescribed for the treatment of a short cervix (GRADE 1B); (6) in individuals without a history of preterm birth who have a sonographic short cervix (10-25 mm), we recommend against cerclage placement in the absence of cervical dilation (GRADE 1B); (7) we recommend that cervical pessary not be placed for the prevention of preterm birth in individuals with a singleton gestation and a short cervix (GRADE 1B); and (8) we recommend against routine use of progesterone, pessary, or cerclage for the treatment of cervical shortening in twin gestations outside the context of a clinical trial (GRADE 1B).
摘要：
妊娠34周之前的大多数分娩发生在没有早产史的个体中。通过经阴道超声评估中期宫颈长度是自发性早产的最佳临床预测因素之一。本咨询为无早产史的个体短宫颈的诊断和管理提供指导。以下是母胎医学协会的建议：（1）我们建议所有用于指导治疗建议的宫颈长度测量都应使用经阴道方法进行，并按照围产期质量基金会或胎儿医学基金会（GRADE1C）等组织描述的标准程序进行，（2）我们建议使用中期宫颈长度≤25毫米的宫颈长度≤25毫米的宫颈，在单胎妊娠前，我们建议在20个月妊娠的个体中诊断为21毫米（GRA包括复合制剂，不用于治疗短宫颈（1B级）;（6）在没有早产史的个体中，有超声检查短宫颈（10-25毫米），我们建议不要在没有宫颈扩张的情况下放置环扎术（Grade1B）;（7）我们建议不要放置宫颈阴道栓以预防单胎妊娠和子宫颈短（Grade1B）的早产;（8）我们建议不要常规使用孕酮，子宫托,或环扎术治疗宫颈缩短双胎妊娠在临床试验的背景下（等级1B）。
