Guzman E R, Vintzileos A M, McLean D A, Martins M E, Benito C W, Hanley M L
Department of Obstetrics and Gynecology and Reproductive Sciences, University of Medicine and Dentistry-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Am J Obstet Gynecol. 1997 Mar;176(3):634-8. doi: 10.1016/s0002-9378(97)70560-x.
Our purpose was to observe the evolution of the endocervical canal length in women at risk for cervical incompetence after a positive response to transfundal pressure.
Ten women at risk for cervical incompetence had a midtrimester cervical evaluation with transvaginal ultrasonography and transfundal pressure. With a transvaginal probe, the endocervical canal length was first measured. Transfundal pressure was then applied and the endocervical canal length was remeasured. All patients had a positive response to transfundal pressure as defined by a decrease in endocervical canal length after application of transfundal pressure. At the initial evaluation the digital examination of the cervix had revealed a closed and long cervix in all 10 cases. In 9 of the 10 patients repeat examinations were performed until the endocervical canal length progressively shortened to <10 mm or the digital examination revealed a dilated cervix. The endocervical canal lengths after application of transfundal pressure from the first and last examination were compared. One patient was lost to follow-up, but the obstetric outcome was available.
The median time interval between the first and final examination was 7 (2 to 20) days in 9 of the patients. The median (range) gestational age at the first and final examination was 19.0 (15 to 22) weeks (n = 10) and 20.5 (18 to 24) weeks (n = 9), respectively. There was significant shortening of the endocervical canal length from the first to the last examination; 12.2 (4 to 20) mm (n = 10) versus 0.0 (0 to 9.5) mm (n = 9), p = 0.008. Six patients had membranes at the external cervical os before application of transfundal pressure at the last examination. The one patient lost to ultrasonographic follow-up had a pregnancy loss at 23 weeks of gestation, 6 weeks after a positive response to transfundal pressure.
In patients at risk for cervical incompetence, shortening of the endocervical canal length in response to transfundal pressure requires treatment with a cervical cerclage because it is associated with progressive cervical changes over 1 to 3 weeks.
我们的目的是观察经腹加压试验呈阳性反应后，有宫颈机能不全风险的女性宫颈管长度的变化。
10名有宫颈机能不全风险的女性在孕中期接受经阴道超声检查和经腹加压试验进行宫颈评估。使用经阴道探头，首先测量宫颈管长度。然后施加经腹压力，并再次测量宫颈管长度。所有患者经腹加压试验均呈阳性反应，定义为施加经腹压力后宫颈管长度缩短。在初次评估时，对所有10例患者的宫颈进行指检均显示宫颈闭合且较长。10例患者中有9例进行了重复检查，直到宫颈管长度逐渐缩短至<10mm或指检显示宫颈扩张。比较初次检查和末次检查施加经腹压力后的宫颈管长度。1例患者失访，但可获得产科结局。
9例患者初次检查与末次检查之间的中位时间间隔为7（2至20）天。初次检查和末次检查时的中位（范围）孕周分别为19.0（15至22）周（n = 10）和20.5（18至24）周（n = 9）。从初次检查到末次检查，宫颈管长度显著缩短；12.2（4至20）mm（n = 10）对0.0（0至9.5）mm（n = 9），p = 0.008。末次检查施加经腹压力前，6例患者宫颈外口有胎膜。1例失访超声检查的患者在经腹加压试验呈阳性反应6周后的孕23周发生流产。
对于有宫颈机能不全风险的患者，经腹加压试验导致宫颈管长度缩短需要进行宫颈环扎治疗，因为这与1至3周内宫颈的渐进性变化有关。
