Am J Obstet Gynecol. 2024 Aug;231(2):B2-B13. doi: 10.1016/j.ajog.2024.05.006. Epub 2024 May 15.
Most deliveries before 34 weeks of gestation occur in individuals with no previous history of preterm birth. Midtrimester cervical length assessment using transvaginal ultrasound is one of the best clinical predictors of spontaneous preterm birth. This Consult provides guidance for the diagnosis and management of a short cervix in an individual without a history of preterm birth. The following are Society for Maternal-Fetal Medicine recommendations: (1) we recommend that all cervical length measurements used to guide therapeutic recommendations be performed using a transvaginal approach and in accordance with standardized procedures as described by organizations such as the Perinatal Quality Foundation or the Fetal Medicine Foundation (GRADE 1C); (2) we recommend using a midtrimester cervical length of ≤25 mm to diagnose a short cervix in individuals with a singleton gestation and no previous history of spontaneous preterm birth (GRADE 1C); (3) we recommend that asymptomatic individuals with a singleton gestation and a transvaginal cervical length of ≤20 mm diagnosed before 24 weeks of gestation be prescribed vaginal progesterone to reduce the risk of preterm birth (GRADE 1A); (4) we recommend that treatment with vaginal progesterone be considered at a cervical length of 21 to 25 mm based on shared decision-making (GRADE 1B); (5) we recommend that 17-alpha hydroxyprogesterone caproate, including compounded formulations, not be prescribed for the treatment of a short cervix (GRADE 1B); (6) in individuals without a history of preterm birth who have a sonographic short cervix (10-25 mm), we recommend against cerclage placement in the absence of cervical dilation (GRADE 1B); (7) we recommend that cervical pessary not be placed for the prevention of preterm birth in individuals with a singleton gestation and a short cervix (GRADE 1B); and (8) we recommend against routine use of progesterone, pessary, or cerclage for the treatment of cervical shortening in twin gestations outside the context of a clinical trial (GRADE 1B).
大多数在 34 周前分娩的情况发生在没有早产史的个体中。使用经阴道超声进行的中孕期宫颈长度评估是自发性早产的最佳临床预测指标之一。本咨询提供了针对无早产史个体的短宫颈的诊断和管理指南。以下是母胎医学学会的建议：（1）我们建议所有用于指导治疗建议的宫颈长度测量均使用经阴道方法，并按照围产期质量基金会或胎儿医学基金会等组织描述的标准化程序进行（GRADE 1C）；（2）我们建议将中孕期宫颈长度≤25mm 用于诊断无自发性早产史的单胎妊娠个体的短宫颈（GRADE 1C）；（3）我们建议在妊娠 24 周前诊断为无症状的单胎妊娠且经阴道宫颈长度≤20mm 的个体，给予阴道孕酮以降低早产风险（GRADE 1A）；（4）我们建议根据共同决策，在宫颈长度为 21-25mm 时考虑阴道孕酮治疗（GRADE 1B）；（5）我们建议不将 17-α羟孕酮己酸酯（包括复方制剂）用于治疗短宫颈（GRADE 1B）；（6）对于无早产史且超声检查发现宫颈较短（10-25mm）的个体，我们建议在没有宫颈扩张的情况下不放置宫颈环扎术（GRADE 1B）；（7）我们建议对于单胎妊娠且宫颈较短的个体，不使用宫颈扩张器来预防早产（GRADE 1B）；（8）我们建议在临床试验以外的情况下，不常规使用孕激素、扩张器或宫颈环扎术来治疗双胎妊娠的宫颈缩短（GRADE 1B）。
