宫颈机能不全是否可以保守治疗() 详解.ppt

阴道应用孕酮对＜33周早产的作用 CONCLUSION: Vaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality. Romero R et al. Am J Obstet Gynecol 2012 Vaginal progesterone in women with an asymptomatic short cervix in the midtrimester ultrasound decrease PTD (N=775) Romero et al. AJOG. 2012. Short cervical length Preterm birth 33 weeks Placebo Vaginal Progesterone RR (95% CI) Twins 44.8% (13/29) 30.4% (7/23) 0.70 (0.34-1.44) Romero R, Nicolaides K, Conde-Agudelo A, Tabor A, O’Brien J, Cetingoz E, DA Fonseca E, Creasy G, Klein K, Rode L, Soma-Pillay P, Fusey S, Cam C, Alfirevic Z, Hassan S Am J Obstet Gynecol 2011;12:003 阴道应用孕酮对双胎早产的作用 * 孕酮预防早产 Cervical cerclage pessary * Guidelines for the management of spontaneous preterm labor: identification of spontaneous preterm labor, diagnosis of preterm premature rupture of membranes, and preventive tools for preterm birth The Journal of Maternal-Fetal and Neonatal Medicine, May 2011; 24(5): 659–667 Cervical cerclage pessary 预防效果有争议： Hui SY（香港中大）一项随机对照研究 4438名低危单胎妇女，20-24周筛查宫颈管长度 宫颈管25 mm者--203 名(4.6%) 108例参与随机对照研究， 分别53例/55例--宫颈托/对照组 小于34周早产率：9.4% VS 5.5% (p=0.46) 结论：预防性应用子宫托未能降低34周前早产率 * Am J Perinatol. 2013 Apr;30(4):283-8 Thank you * * * 对于在≤ 32孕周时的自然早产的宫颈长度阳性预测值在 25 mm时为32%。在既往有早产且宫颈 25 mm的女性中的OR为1.84，而如果她们是黑人，且宫颈短，则为2.25。如果宫颈小于15mm，且胎儿纤连蛋白为阳性，则32周前的分娩频率为75%。 * * 宫颈机能不全是否可以保守治疗? 暨南大学附属第一医院妇产科 肖小敏 xiaoxiaomin55@ Incompetent Cervix Characters Painless cervical dilatation in second trimester or perhaps early in the third trimester With prolapse and ballooning of membranes into the vagina Followed by rupture of membranes and expulwion of an immatrue fetus Unless effectively treated, this sequence tends to repeat in each pregnancy Diagnosis ? EffectiveTreatments ? * * 宫颈机能不全 定义：在没有宫缩的情况下，子宫颈由于解剖或功能缺陷不能维持妊娠至足月 诊断： 病史：妊娠中期反复自然流产、早产史 非孕期诊断:（争议） 8号扩张器探宫颈内口无阻力 子宫输卵管碘油造影→宫颈内口宽度＞6