宫颈托预防早产的研究进展

Research Progress of Pessary Use for Preventing Preterm Birth

宫颈托是近年来逐渐兴起的一种早产治疗方法,作用机制尚不明确,可能与压紧宫颈管并改变其角度有关。宫颈托类型多样,近年临床上Arabin托较常用,其半球形设计与阴道穹窿结构相似,可尽量包绕宫颈至内口。宫颈托放置术前应根据孕妇的临床情况和宫颈形态选择合适的型号。目前诸多国内外研究显示宫颈托在早产高危人群如宫颈机能不全、双胎中的防治效果显著,可延长分娩孕周、降低早产的发生率,减少围生儿不良结局的发生。与阴道用孕激素及宫颈环扎术等其他治疗方法相比,宫颈托的不良反应少,主要为阴道排液增多,此外其具有取放方便、无需麻醉,无侵入性且花费低等优点。目前由于缺乏大量高质量的随机对照试验,尚需进一步研究证实其疗效。

The pessary has emerged as a possible treatment for the prevention of preterm birth ,the exact mechanism in reducing the likelihood of preterm birth is unknown,one hypothese suggested that the pessary encompasses the cervix and changes the uterocervical angle. Different models of pessaries are used to prevent preterm birth and among them the most widely used is Arabin pessary. Its dome-like design resembled the vaginal fornix ,surrounded the cervix as close as possible to internal. The pessary size should be choiced according to the clinical situation and cervical morphology. In recent years ,many studies have shown that the use of pessary can significantly prolong the delivery gestational age, reduce the rate of preterm birth and poor perinatal outcome,especially in high risk population of women such as cervical incompetence and twins pregnancy. Compared with the other methods,like the use of progesterone in vagina and cervical cerclage, there′s no significant side effects have been reported,the most common complaint is an increase in vaginal discharge, besides,cervical pessary can be inserted and removed easily without the need for anesthesia and is noninvasive and inexpensive. However ,due to the lack of available high quality randomized controlled trials,the benefit of the cervical pessary could not be confirmed and further research is urgently needed.