Abenhaim Haim A, Tulandi Togas
Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
J Matern Fetal Neonatal Med. 2009 Jun;22(6):510-6. doi: 10.1080/14767050902794733.
Historically, placement of a cervical cerclage was based almost entirely on the obstetrical history. Over the past two decades however, we have recognised that history alone may not be the only indication for cerclage but rather, complementing the obstetrical history with ultrasonographic and biochemical findings may better identify those women who may benefit most from the placement of a cervical cerclage. Review of the literature appears to suggest that the best approach towards the management of a cervical insufficiency is to first categorise women as being either high risk of low risk-based on obstetrical history. Although women with an obstetrical history of at least three 2nd trimester losses are likely to benefit from a prophylactic cerclage than those without this history may better be managed with progesterone and serial cervical length measurements. This approach can in turn be used to identify those women with early cervical shortening that may require an emergency cerclage. Although randomised controlled trials are still lacking, recent studies suggests that this approach may be more effective especially when combined with markers of intra-amniotic inflammation. As for the prophylactic cerclage itself, with the abdominal cerclage being less invasive given the possibility of a laparoscopic placement, it may prove to be a more effective alternative to the conventionally placed McDonald cerclage. This however, remains to be evaluated more carefully.
从历史上看，宫颈环扎术的实施几乎完全基于产科病史。然而，在过去二十年中，我们认识到仅凭病史可能并非宫颈环扎术的唯一指征，而是将超声检查和生化检查结果与产科病史相结合，可能会更好地识别出那些最有可能从宫颈环扎术中获益的女性。文献综述似乎表明，处理宫颈机能不全的最佳方法是首先根据产科病史将女性分为高风险或低风险。虽然有至少三次孕中期流产产科病史的女性可能比没有这种病史的女性更能从预防性宫颈环扎术中获益，但后者可能用孕激素和连续宫颈长度测量来更好地管理。这种方法反过来可用于识别那些可能需要紧急宫颈环扎术的早期宫颈缩短的女性。尽管仍然缺乏随机对照试验，但最近的研究表明，这种方法可能更有效，尤其是与羊膜腔内炎症标志物联合使用时。至于预防性宫颈环扎术本身，鉴于腹腔镜放置的可能性，腹部宫颈环扎术侵入性较小，它可能被证明是传统放置的麦克唐纳宫颈环扎术更有效的替代方法。然而，这仍有待更仔细地评估。
