宫颈机能不全诊治上的困惑

Confusion in Diagnosis and Treatment of Cervical Insufficiency

宫颈机能不全作为早产综合征的一个重要组成部分,是导致流产、早产的主要原因之一。宫颈机能不全诊断主要包括既往病史、此次妊娠的临床表现、超声多普勒和妊娠前诊断试验等。预测宫颈机能不全,目前主要包括对双胎/多胎妊娠、多囊卵巢综合征、宫颈锥切术和肥胖等高危因素的监测。对于合并这些高危因素的孕妇,孕期应积极定期监测宫颈长度,及时发现宫颈缩短并给予临床干预,对于降低早产和流产率、改善妊娠结局具有非常重要的意义。目前为止,宫颈机能不全尚无统一的诊断标准,也没有可靠的血清学指标可以预测宫颈机能不全。现从宫颈机能不全的病因、诊断和高危因素预测方面进行综述。

The cervical insufficiency as an important component of preterm birth syndrome is one of the main causes of miscarriage and premature birth. The diagnosis of cervical insufficiency mainly includes the medical history, the clinical manifestation of this pregnancy, ultrasound Doppler and pre-pregnancy diagnosis test.Some high-risk factors may be helpful for the prediction of cervical insufficiency, including twin/multiple pregnancy, polycystic ovary syndrome, cervical conization and obesity. For those pregnant women with the high-risk factors, the length of the cervix should be monitored regularly during pregnancy. The cervical shortening should be found and treated in time, which is of great significance for reducing preterm birth rate and abortion rate, and improving pregnancy outcome. So far, there is no uniform standard for its diagnosis, and there are no reliable serological indicators for predicting cervical insufficiency. We discussed the etiology and diagnosis of cervical insufficiency, as well as the prediction of high-risk factors.