宫颈机能不全指南解读.pptxVIP

会计学1宫颈机能不全指南解读 Cervical insufficiency: definitionThe 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 trimesterA short cervical length in the second trimester is not sufficient for the diagnosis. 第1页/共32页 Cervical conizationLEEPMechanical dilationObstetric lacerationsCongenital müllerian anomaliesDeficiencies in cervical collagen and elastinUtero exposure to diethylstilbestrolAnd so on.Cervical insufficiency: etiology第2页/共32页 Cervical insufficiency: diagnosisChallenging because of a lack of objective findings and clear diagnostic criteria. Diagnosis is based on historyPainless cervical dilation and expulsion of the pregnancy in the second trimesterWithout contractions or laborIn the absence of other clear pathology第3页/共32页 Can the identification of cervical shortening by TVS be an ultrasonographic diagnostic marker of cervical insufficiency?Cervical insufficiency: diagnosisShort cervical length has been shown to be a marker of preterm birth in general rather than a specific marker of cervical insufficiency.第4页/共32页 Diagnostic tests should not be used to diagnose cervical insufficiency.HysterosalpingographyRadiographic imaging of balloon traction on the cervixAssessment of the patulous cervix with Hegar or Pratt dilatorsBalloon elastance testCervical dilators to calculate a cervical resistance indexCervical insufficiency: diagnosis第5页/共32页 Cervical insufficiency: treatment optionsNon-surgical treatmentVaginal progesteroneVaginal pessary Activity restriction Bed rest Pelvic rest Non-surgical treatmentTransvaginal cervical cerclage: McDonald procedure and Shirodkar procedureTransabdominal cervical cerclage: laparotomy, laparoscopy and Robotic-assisted第6页/共32页 Cervical insufficiency: treatment optionsIn which situations should Transabdominal cervical cerclage be considered?Failed transvaginal cervical c