Perrotin F, Lansac J, Body G
Département de Gynécologie Obstétrique, Médecine Foetale et Reproduction Humaine, Hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours Cedex 1, France.
J Gynecol Obstet Biol Reprod (Paris). 2002 Nov;31(7 Suppl):5S66-73.
Cervical cerclage is not recognized as the usual treatment of threatened premature delivery including uterine contractions and cervical modifications. Pregnant women with a threatened premature delivery limited to the presence of a short cervix at digital examination or internal scan may however be offered therapeutic cerclage, different from prophylactic first trimester cervical cerclage, when cervical insufficiency is suspected. Studies on cervical cerclage to prevent premature delivery suffered a poor design and do not allow any strong definitive conclusion. In the presence of a shortened or dilated cervix at digital examination without uterine contractions, there is no strong scientific evidence to support the practice of therapeutic cervical cerclage. Conversely there is however no strong scientific evidence to reject this procedure especially in early pregnancy (before the end of the second trimester). Therefore therapeutic cervical cerclage remains a possible option only if premature labor, intrauterine infection or placental abruption have been ruled-out by a 48 hours inpatient bed rest. In patients without previous history of premature delivery or second trimester miscarriage, there is no scientific evidence to support therapeutic cervical cerclage in presence of a short cervix. Moreover, in this low-risk group cervical length ultrasound screening is not recommended. In patients with one or more previous premature deliveries or second trimester miscarriage but who do not reach Royal College criteria for prophylactic cervical cerclage, there is currently not enough evidence to support a policy of therapeutic cervical cerclage compared to bed rest. This latter recommendation may however depend on the severity of previous obstetrical history.
宫颈环扎术并非被公认为是治疗包括子宫收缩和宫颈改变在内的先兆早产的常规方法。然而，对于那些在指诊或经阴道超声检查时仅发现宫颈短而被诊断为先兆早产的孕妇，当怀疑有宫颈机能不全时，可考虑进行治疗性宫颈环扎术，这与孕早期预防性宫颈环扎术不同。关于宫颈环扎术预防早产的研究设计欠佳，无法得出任何强有力的确定性结论。在指诊时发现宫颈缩短或扩张但无子宫收缩的情况下，没有强有力的科学证据支持治疗性宫颈环扎术的实施。相反，也没有强有力的科学证据反对这一手术，尤其是在孕早期（妊娠中期结束前）。因此，只有在经过48小时住院卧床休息排除早产、宫内感染或胎盘早剥后，治疗性宫颈环扎术才仍然是一种可能的选择。对于既往无早产或妊娠中期流产史的患者，没有科学证据支持在宫颈短的情况下进行治疗性宫颈环扎术。此外，在这个低风险组中，不建议进行宫颈长度超声筛查。对于有一次或多次既往早产或妊娠中期流产史但未达到皇家学院预防性宫颈环扎术标准的患者，与卧床休息相比，目前没有足够的证据支持治疗性宫颈环扎术的策略。然而，后一项建议可能取决于既往产科病史的严重程度。
