宫颈机能不全的孕前诊断方法及评价

The progestational diagnostic methods of cervical incompetence

宫颈机能不全是妊娠期因子宫局部因素导致围产儿发病率与病死率的主要原因，其发生率约0.1％～1．0％。孕前病史如流产与早产病史、孕前子宫畸形病史、宫颈手术病史等是诊断宫颈机能不全的关键；其次为影像学检查，最常用的方法为阴道超声，X光下子宫输卵管造影、磁共振成像已较少采用；宫颈内口扩条探查法及Foley导管水囊牵拉试验在诊断时有一定主观性，且有宫腔感染风险，在临床上也较少使用；腹腔镜及宫腔镜检查受技术及设备限制，一般医院较少开展。此外，宫颈机能不全可能与基因变化有关，但尚未得到证实。综合病史及辅助检查，在孕前早发现、早诊断，并予以正确的孕前指导和治疗，可在一定程度上避免再次妊娠的丢失与早产，改善妊娠结局。

Cervical incompetence is the major cause of perinatal morbidity and mortality rate due to uterine factors, the occurrence rate is about O. 1% - 1%. Pregnancy history such as abortion and preterm birth history, uterine malformation and cervical operation history is critical to the diagnosis of cervical incompetence ; Next is imaging examination, the most commonly used method is vaginal ultrasound, hysterosalpingography under X-ray and magnetic reso- nance imaging has been less used ; Passage of dilator through the internal os and the Foley traction test has some subjectivity at the time of diagnosis, and it has the risk of intrauterine infection, so they have been less used in clinical hospital;Laparoscopy and hyste- roscopy examination are rarely used because of the technology and equipment constraints ; In addition, cervical incompetence may be related to gene expression, but has not yet been confirmed. Combine the history with auxiliary examination to diagnose earlier and give proper treatment, we can avoid pregnancy loss and premature birth to a certain extent, and im- prove the pregnancy outcome.