宫颈托预防自发性流产和早产的价值及随访注意事项

Pessary Placement in the Prevention of Spontaneous Preterm Birth and Its Follow-up

预防自发性流产和早产是世界范围内重要的公共卫生问题。宫颈托可能是预防单胎或双胎妊娠因宫颈缩短而导致自发性流产和早产的一种潜在治疗方法。该方法是一种易接受,不良反应较小,成本较低,且易于放置及取出的治疗。目前对于宫颈托的疗效尚不明确,已有的研究结果相互矛盾。根据同济大学附属第一妇婴保健院放置宫颈托经验,重点随访孕妇主诉、阴道分泌物情况和宫颈情况,并同时评估放置宫颈托是否可以改善宫颈机能不全孕妇母儿结局。宫颈托在宫颈缩短或有自发性流产、早产史的单胎或双胎孕妇中的疗效及其是否可以联合其他方法治疗宫颈机能不全以达到最大效果,目前仍需要大样本多中心前瞻性随机对照研究来证实。

Prevention of spontaneous preterm birth is an important public health priority.Pessary may be a potential therapy in cases of cervical insufficiency in singleton and multiple gestations.As a promise alternative treatment for women with cervical insufficiency,cervical pessary is an attractive option given that it is noninvasive,easy to use,low cost,not requiring anesthesia and can be easily placed and removed.At present,many studies have shown conflicting results.In our hospital,we followed up these patients for the complaints,vaginal discharge and cervical length after placing cervical pessary for cervical insufficiency.The aim was to evaluate the effectiveness of adjunctive pessary therapy after cervical cerclage in improving perinatal outcome in women with cervical insufficiency.In the meantime,further large multicenter,randomized,controlled prospective studies are warranted to define the contribution of each treatment option for short cervix and how they may be combined for maximum effect.