■宫颈环扎术(CC)是目前可用于预防由宫颈机能不全引起的早产的少数有效措施之一,从而有助于降低新生儿发病率和死亡率。
这项研究的目的是回顾和比较最近发表的关于适应症的主要指南,禁忌症,技术,以及CC的放置和移除时间。
■对美国妇产科医师学会(ACOG)指南的描述性审查,皇家妇产科学院(RCOG),加拿大妇产科医师协会(SOGC),国际妇产科联合会(FIGO)在CC上进行了。
■在所审查的指南中就推荐的技术达成了共识,救援CC的指示,禁忌症,以及CC放置和移除的最佳时机。所有医学协会都同意,超声指示的CC在有自发性PTD或中期流产病史且在超声检查中检测到宫颈长度短的女性中是合理的。此外,在CC之后,宫颈长度的连续超声测量,卧床休息,和常规使用抗生素,宫溶疗法,和黄体酮被一致劝阻。在确定早产的情况下,CC应该被删除,根据ACOG,RCOG,SOGC。此外,RCOG和SOGC同意在尝试CC之前应满足的先决条件。这2个指南以及FIGO为3个或更多以前早产和/或中期妊娠流产的女性推荐了病史指示的CC,而ACOG建议在单胎妊娠中使用CC,这些妊娠有1个或更多与无痛性宫颈扩张相关的妊娠中期流产,或在妊娠中期由于无痛性宫颈扩张而先前的CC。羊膜穿刺术在抢救CC之前排除羊膜腔内感染的作用仍存在争议。
■宫颈环扎术是一种产科干预措施,用于预防被认为是这些常见妊娠并发症高风险的妇女的流产和早产。制定关于安置CC的普遍国际惯例议定书似乎至关重要,有望改善此类怀孕的结果。
UNASSIGNED: Cervical cerclage (CC) represents one of the few effective measures currently available for the prevention of preterm delivery caused by cervical insufficiency, thus contributing in the reduction of neonatal morbidity and mortality rates.
UNASSIGNED: The aim of this study was to review and compare the most recently published major
guidelines on the indications, contraindications, techniques, and timing of placing and removal of CC.
UNASSIGNED: A descriptive review of
guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the International Federation of Gynecology and Obstetrics (FIGO) on CC was carried out.
UNASSIGNED: There is a
consensus among the reviewed
guidelines regarding the recommended techniques, the indications for rescue CC, the contraindications, as well as the optimal timing of CC placement and removal. All medical societies also agree that ultrasound-indicated CC is justified in women with history of prior spontaneous PTD or mid-trimester miscarriage and a short cervical length detected on ultrasound. In addition, after CC, serial sonographic measurement of the cervical length, bed rest, and routine use of antibiotics, tocolysis, and progesterone are unanimously discouraged. In case of established preterm labor, CC should be removed, according to ACOG, RCOG, and SOGC. Furthermore, RCOG and SOGC agree on the prerequisites that should be met before attempting CC. These 2
guidelines along with FIGO recommend history-indicated CC for women with 3 or more previous preterm deliveries and/or second trimester pregnancy miscarriages, whereas the ACOG suggests the use of CC in singleton pregnancies with 1 or more previous second trimester miscarriages related to painless cervical dilation or prior CC due to painless cervical dilation in the second trimester. The role of amniocentesis in ruling out intra-amniotic infection before rescue CC remains a matter of debate.
UNASSIGNED: Cervical cerclage is an obstetric intervention used to prevent miscarriage and preterm delivery in women considered as high-risk for these common pregnancy complications. The development of universal international practice protocols for the placement of CC seems of paramount importance and will hopefully improve the outcomes of such pregnancies.