Medical Student, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton.
Clinical Associate Professor, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne; Senior Consultant Gynaecologist, Royal Women's Hospital, Parkville; Consultant Gynaecological Surgeon.
Obstet Gynecol Surv. 2020 Dec;75(12):757-765. doi: 10.1097/OGX.0000000000000847.
Cervical insufficiency (CI) is a serious complication of pregnancy, which can cause preterm birth. Identifying how to most effectively treat CI has the potential to maximize neonatal survival in this population of women.
To determine whether transabdominal cervical cerclage should be offered as a first-line treatment option in high-risk women.
An electronic literature search for relevant studies was conducted using keywords (CI, cervical cerclage) on the MEDLINE database.
Although transabdominal cerclage (TAC) is reserved as a second-line treatment option over transvaginal cerclage (TVC), it has some advantages over TVC: a higher placement of the suture at the level of the cervicoisthmic junction; avoidance of placement of foreign material in the vagina, in turn, reducing risk of infection and inflammation, which can propagate preterm labor; and the option to leave the suture in place for future pregnancies. Systematic review evidence offers TAC as a more effective procedure to TVC in reducing preterm birth and maximizing neonatal survival. Although TAC is a slightly more complex procedure compared with TVC, advances in minimally invasive surgery now allow gynecologists to perform this more effective procedure laparoscopically and therefore without the added morbidity of open surgery but with the same if not better outcomes.
Laparoscopic TAC can provide a more effective treatment option for CI without the added burdens of open abdominal surgery.
Our article highlights future directions for study in the area of cervical cerclage and refinement of existing practices.
宫颈机能不全（CI）是妊娠的严重并发症，可导致早产。确定如何最有效地治疗 CI 有可能最大限度地提高该人群中新生儿的存活率。
确定经腹宫颈环扎术是否应作为高危妇女的一线治疗选择。
使用 MEDLINE 数据库中的关键字（CI、宫颈环扎术）对相关研究进行了电子文献检索。
尽管经腹环扎术（TAC）被保留为经阴道环扎术（TVC）的二线治疗选择，但它与 TVC 相比具有一些优势：缝线在宫颈峡部交界处的位置更高；避免将异物放置在阴道中，从而降低感染和炎症的风险，从而引发早产；并且可以为未来的妊娠保留缝线。系统评价证据表明，TAC 可更有效地减少早产并最大限度地提高新生儿存活率。尽管与 TVC 相比，TAC 是一种稍微复杂的手术，但微创外科技术的进步现在使妇科医生能够通过腹腔镜进行这种更有效的手术，因此无需额外的开腹手术的发病率，但具有相同甚至更好的结果。
腹腔镜 TAC 可为 CI 提供更有效的治疗选择，而不会增加开腹手术的负担。
我们的文章强调了在宫颈环扎术领域进行未来研究和完善现有实践的方向。
