Makino Yasuo, Makino Ikuko, Tsujioka Hiroshi, Kawarabayashi Tatsuhiko
Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan.
J Perinat Med. 2004;32(2):140-8. doi: 10.1515/JPM.2004.026.
To determine whether an amnioreduction via bulging membranes (AVBM) and cerclage could be useful in 17 women with singleton gestations demonstrating hourglass membranes bulging out of the cervix or vaginal orifice.
We used the following selection criteria for AVBM under ultrasonographic guidance using a peit needle because of undetectable cervical edges: (type 1) the bag of membranes protruded beyond the inlet of the vagina; (type 2) the bag of huge membranes completely occupied the vagina.
Eight patients (three cases of type 1 and five of type 2) were successful in AVBM and cerclage at 22.1 +/- 2.2 weeks gestation (range 19-24 weeks), and mean birth weight was 1,048.1 +/- 801.6 g (range 302-2,688 g). Although the diameter of the forewater by transabdominal ultrasonography (cm) was higher than in the nine patients without AVBM (6.7 +/- 1.1 versus 4.1 +/- 0.7 cm, p = 0.002), the prolongation of pregnancy (32.9 +/- 46.2 days; range 2-133 days) was the same as in patients without AVBM (36.9 +/- 39.3 day, p = 1.000).
It is important that every effort should be made to perform cervical cerclage at or before 26 weeks of gestation, even in women with type 1 or 2.
确定对于17例单胎妊娠且宫颈或阴道口有沙漏状胎膜膨出的孕妇，经膨出胎膜羊膜腔穿刺减压术（AVBM）联合宫颈环扎术是否有效。
由于宫颈边缘无法检测，我们在超声引导下使用佩特针进行AVBM时采用以下选择标准：（1型）胎膜囊突出超过阴道口；（2型）巨大的胎膜囊完全占据阴道。
8例患者（3例1型和5例2型）在妊娠22.1±2.2周（范围19 - 24周）成功进行了AVBM和宫颈环扎术，平均出生体重为1,048.1±801.6克（范围302 - 2,688克）。虽然经腹部超声测量的羊水直径（厘米）高于9例未进行AVBM的患者（6.7±1.1对4.1±0.7厘米，p = 0.002），但妊娠延长时间（32.9±46.2天；范围2 - 133天）与未进行AVBM的患者相同（36.9±39.3天，p = 1.000）。
即使对于1型或2型患者，在妊娠26周或之前尽一切努力进行宫颈环扎术很重要。
