宫颈机能不全的孕期诊断及评价-张向丽

ingcervicalconizationJ．ArchGynecolObstet20112834765-769.6BoccaSMAbuhamadAZ．Useof3-DimensionalSonographytoassessUterineAnomaliesJ．JUltrasoundMed2013.321-6.7JolleyJAWingDA．Pregnancymanagementaftercervicalsur-geryJ．CurrOpinObstetGynecol2008206528-533.8DeutchTDAbuhamadAZ．Theroleof3-dimensionalultra-sonographyandmagneticresonanceimaginginthediagnosisofmullerianductanomaliesareviewoftheliteratureJ．JUltra-soundMed200827413-423.9BosteelsJKasiusJWeyersSetal．Hysteroscopyfortreatingsubfertilityassociatedwithsuspectedmajoruterinecavityabnor-malitiesJ．CochraneDatabaseSystＲev2013311CD009461.10BauerMMazzaENavaAetal．InvivocharacterizationofthemechanicsofhumanuterinecervicesJ．AnnNYAcadSci20071101186-202.11SchlembachDMackayLShiLetal．CervicalripeningandinsufficiencyfrombiochemicalandmolecularstudiestoinvivoclinicalexaminationJ．EurJObstetGynecolＲeprodBiol2009144Suppl1S70-76.12WarrenJESilverＲMDaltonJetal．Collagen1Alpha1andtransforminggrowthfactor-betapolymorphismsinwomenwithcervicalinsufficiencyJ．ObstetGynecol20071103619-62[e-mail]张向丽宫颈机能不全(cervicalincompetence，CIC)孕期诊断主要依靠:既往病史和临床症状、阴道检查、超声检查结果;对CIC的诊断通常仅限于单胎妊娠。至少两次28周前的妊娠流产(无痛性宫颈扩张)病史可作为CIC诊断的独立指标;在妊娠24周前的初产妇或经产妇(无多次流产史的)，当阴道超声提示其宫颈长度﹤25mm和(或)查体时发现宫颈有进行性的变化，结合一次以上的14-36周妊娠流产(或早产史)或明确的CIC发生高危因素可以作出CIC的诊断。宫颈机能不全;无痛性宫颈扩张;宫颈长度;阴道超声Ｒ711.74CDiagnosisandevaluationofcervicalincompe-tenceduringpregnancy．ZHANGXiang-li．Depart-mentofObstetricsandGynecologyQiluHospitalofShandongUniversityJinan250012ChinaAbstractThediagnosisofcervicalincompetenceCICduringpregnancymainlyisbasedbothonclinicalfindingscervicalcharacteristicsultrasoundstudiesandontheprevioushistoryofthepatient．Diagnosisofcervicalincompetenceisusuallylimitedinsinglepregnancy．Usinghistoricfactorsalonecervicalinsufficiencyisdefinedaspainlesscervicaldilatationleadingtorecurrentsecondtrimesterpreg-nancylosses/birthsatleasttwicebefore28weeksofgestationhaveoccurred．CervicalinsufficiencyisdiagnosedbyTVUcervicallength＜25mmand/oradvancedcervicalchangesonphysicalexaminationbefore24weeksofgestationinprimigravidasorinmultigravidaswithoutmultiplepriorpregnancylos-seswitheitheroneormorepriorpregnancylossesorpretermbirthsat14to36weeksand/orothersignif-icantriskfactorsforcervicalinsufficiency．KeywordscervicalincompetencepainlesscervicaldilatationcervicallengthtransvaginalultrasoundcervicalincompetenceCIC1。20%～25%10%～15%2。11.1ACOG2003、、。、、、、CIC。CIC1V。2①②③。324～283。1.220051·39·2014230220～22。、。22cm。3①30%②10mm③30mm4。1.35200862010CIC1＞3cm。22.5～3cm。3＜3cmVU。1.4《》1。2。3B＞1.5cm7。121。。2Debbs12009、、FGＲ、、。20137Berghella8CIC。CIC。CIC12。、8。2.12.1.1。2.1.2、。14～20。、、。。2.1.3、Valsalva≥4cm≥80%。。2.1.428tansvaginalultra-soundTVUcervicallengthCL1025mm。2.1.5CICCIC、。2.2CICTVU。1CIC28。224TVU25mm①14～361。②CIC、、、、、CIN。3CIC14～28。2.3123CIC1B。2CIC14～1624＜25mm2B。31B。3CIC、LEEP99Vyas10CICCICCICPeleg114、CIC。Koyama122010·49·201423022CIC。。、69%13。4、CIC。30。14～284cm164.3cm2.5cm3。5CICCICTVU≤3cmCL≤2cm。TVU。2.5cmCIC55%14。CIC15。32182～3cm。1434。CIC6。5TVU3780108、。CIC2。59%n=26＞25mm34。Berghella11136%＜25mm。20.4%0.36%。25mm。30114799V48U。U。UV。U33.8±6.628.9±6.916。Song1739CL33CL33.736.5P＜0.001。P0.001。P=0.49。Ouzounian181999－2008。logistic。132P=0.005P=0.01。2cm32OＲ5.7495%1.78～18.5P=0.003。Berghella1925mm。CICTVUU、。。、、、、、1。。TVU、、。1DebbsＲHChenJ．ContemporaryuseofcerclageinpregnancyJ．ClinObstetGynecol2009524597-610.2AlthuisiusSMDekkerGAvanGeijnHPetal．Ｒandomized·59·20142302cerclagetrialstudydesignandpreliminaryresultsJ．AmJObstetGynecol20001834823-829.3AmericanCollegeofObstericiansandGynecologists．ACOGPrac-ticeBulletin．CervicalinsufficiencyJ．ObstetGynecol20031025Pt11091-1099.4．J．2005214210-213.5．J．2008431061-63.6．J．201021114-16.7．J．20138932-34.8BerghellaV．CervicalinsufficiencyEB/OL．http//．up-todate．com/contents/cervical-insufficiencyLiteraturereviewcurrentthroughSep2013.UpToDate．9．54J．20044612-13．10VyasNAVinkJSGhidiniAetal．ＲiskfactorsforcervicalinsufficiencyaftertermdeliveryJ．AmJObstetGynecol2006195787-791.11PelegDPerlitzYPanskySetal．AccidentaldeliverythroughavaginalincisionlaparoelytrotomyduringcaesareansectioninthesecondstageoflabourJ．BrJObstetGynecol2001108659-660.12KoyamaS．Cervicalinsufficiencyfollowingcesareandeliveryaf-terprolongedsecondstageoflaborExperiencesoftwocasesJ．JObstetGynaecolＲes2010362411-413.13HaneyAF．PrenatalDESexposurethecontinuingeffectsJ．OBGManagement20021333-44．14OwenJIamsJDHauthJ．VaginalsonographyandcervicalincompetenceJ．AmJObstetGynecol20031882586-596.15IncertiMGhidiniALocatelliAetal．Cervicallength≤25mminlow-riskwomenacasecontrolstudyofcerclagewithrestvsrestaloneJ．AmJObstetGynecol20071973315.e1-e4.16MancusoMSSzychowskiJMOwenJetal．Cervicalfunne-lingeffectongestationallengthandultrasoundindicatedcer-clageinhigh-riskwomenJ．AmJObstetGynecol20102033259.e1-259.e5.17SongJELeeKYKimMYetal．Cervicalfunnelingaftercer-clageincervicalincompetenceasapredictorofpregnancyout-comeJ．JMaternFetalNeonatalMed2012252147-150.18OuzounianJGKorstLMLeeＲH．Cervicallengthanddeliv-eryoutcomesinpatientswithprophylacticcervicalcerclageJ．AmJPerinatol2011284273