《宫颈机能不全指南解读》.pptVIP

* * 宫颈机能不全指南解读 Cervical insufficiency: definition The inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester。 Uterine cervix Absence of the signs and symptoms Second trimester A short cervical length in the second trimester is not sufficient for the diagnosis. Cervical conization LEEP Mechanical dilation Obstetric lacerations Congenital müllerian anomalies Deficiencies in cervical collagen and elastin Utero exposure to diethylstilbestrol And so on. Cervical insufficiency: etiology Cervical insufficiency: diagnosis Challenging because of a lack of objective findings and clear diagnostic criteria. Diagnosis is based on history Painless cervical dilation and expulsion of the pregnancy in the second trimester Without contractions or labor In the absence of other clear pathology Can the identification of cervical shortening by TVS be an ultrasonographic diagnostic marker of cervical insufficiency? Cervical insufficiency: diagnosis Short cervical length has been shown to be a marker of preterm birth in general rather than a specific marker of cervical insufficiency. Diagnostic tests should not be used to diagnose cervical insufficiency. Hysterosalpingography Radiographic imaging of balloon traction on the cervix Assessment of the patulous cervix with Hegar or Pratt dilators Balloon elastance test Cervical dilators to calculate a cervical resistance index Cervical insufficiency: diagnosis Cervical insufficiency: treatment options Non-surgical treatment Vaginal progesterone Vaginal pessary Activity restriction Bed rest Pelvic rest Non-surgical treatment Transvaginal cervical cerclage: McDonald procedure and Shirodkar procedure Transabdominal cervical cerclage: laparotomy, laparoscopy and Robotic-assisted Cervical insufficiency: treatment options In which situations should Transabdominal cervical cerclage be considered? Failed transvaginal cervical cerclage pr