宮頸機(jī)能不全指南解讀宮頸機(jī)能不全指南解讀1CerclageforthemanagementofCervicalInsufficiencyCerclageforthemanagement2Cervicalinsufficiency:definitionTheinabilityoftheuterinecervixtoretainapregnancyintheabsenceofthesignsandsymptomsofclinicalcontractionsorlabor.orbothinthesecondtrimesteroterinecerviXabsenceofthesignsandsymptomsSecondtrimesterashortcervicallengthinthesecondtrimesterisnotsufficientforthediagnosisCervicalinsufficiency:defini3Cervicalinsuficiency:etiologyCervicalconizationLEEPMechanicaldilatObstetriclacerationsCongenitalmulleriananomaliesDeficienciesincervicalcollagenandelastinUteroexposuretodiethystilbestrolAndsoonC4Cervicalinsufficiency:diagnosisChallengingbecauseofalackofobjectivefindingsandcleardiagnosticcriteriaDiagnosisisbasedonhistoryPainlesscervicaldilationandexpulsionofthepregnancyinthesecondtrimester2.Withoutcontractionsorlabor3.IntheabsenceofotherclearpathologyCervicalinsufficiency:diagno5Cervicalinsufficiency:diagnosisCantheidentificationofcervicalshorteningbytvsbeanultrasonographicdiagnosticmarkerofcervicalinsufficiencyShortcervicallengthhasbeenshowntobeamarkerofpretermbirthingeneralratherthanaspecificmarkerOfcervicalinsuFficiency.Cervicalinsufficiency:diagno6Cervicalinsufficiency:diagnosisDiagnostictestsshouldnotbeusedtodiagnosecervicalinsufficiencya.Hysterosalpingographyb.RadiographicimagingofballoontractiononthecervixAssessmentofthepatulouscervixwithHegarorPrattdilatorsd.Balloonelastanceteste.CervicaldilatorstocalculateacervicalresistanceindexCervicalinsufficiency:diagno7Cervicalinsufficiency:treatmentoptionsNon-surgicaltreatmentNon-surgicaltreatment1.Vaginalprogesterone1.Transvaginalcervic2.ⅤaginalpessarycerclageMcDonald3.ActivityrestrictionprocedureandShirodkar4.Bedrestprocedure5.Pelvicrest2.Transabdominalcervicalcerclagelaparotomy,laparoscopyandRobotic-assistedCervicalinsufficiency:treatm8Cervicalinsufficiency:treatmentoptionsInwhichsituationsshouldTransabdominalcervicalcerclagebeconsidered?1.Failedtransvaginalcervicalcerclageprocedureshistory(這個(gè)我持保留意見(jiàn))2.TransvaginalcervicalcerclageprocedurescannotplacebecauseofanatomicallimitationsCervicalinsufficiency:treatm9Cervicalinsufficiency:clinicalconsiderationsandrecommendations1.Cerclageplacementmaybeindicatedbasedonahistoryofcervicalinsufficiency,physicalexaminationfindings,orahistoryofpretermbirthandcertainultrasonographicfindings2.CerclageshouldbelimitedtopregnanciesinthesecondtrimesterbeforefetalviabilityhasbeenachievedCervicalinsufficiency:clinic10IndicationsforCervicalCerclageinWomenWithSingletonPregnanciesHistoryHistoryofoneormoresecond-trimesterpregnancylossesrelatedtopainlesscervicaldilationandinthebsenceoflabororabruptioplacentaePriorcerclageduetopainlesscervicaldilationinthesecondtrimesterPhysicalExaminationPainlesscervicaldilationinthesecondtrimesterUItrasonographicfindingwithahistoryofPriorPretermbirthCurrentsingletonpregnancy,priorspontaneouspretermbirthatlessthan34weeksofgestation,andshortcervicallength(lessthan25mm)before24weeksofgestationIndicationsforCervicalCercl11宮頸機(jī)能不全指南解讀課件12宮頸機(jī)能不全指南解讀課件13宮頸機(jī)能不全指南解讀課件14宮頸機(jī)能不全指南解讀課件15宮頸機(jī)能不全指南解讀課件16宮頸機(jī)能不全指南解讀課件17宮頸機(jī)能不全指南解讀課件18宮頸機(jī)能不全指南解讀課件19宮頸機(jī)能不全指南解讀課件20宮頸機(jī)能不全指南解讀課件21宮頸機(jī)能不全指南解讀課件22宮頸機(jī)能不全指南解讀課件23宮頸機(jī)能不全指南解讀課件24宮頸機(jī)能不全指南解讀課件25宮頸機(jī)能不全指南解讀課件26宮頸機(jī)能不全指南解讀課件27宮頸機(jī)能不全指南解讀課件28宮頸機(jī)能不全指南解讀課件29宮頸機(jī)能不全指南解讀課件30宮頸機(jī)能不全指南解讀課件31宮頸機(jī)能不全指南解讀課件32宮頸機(jī)能不全指南解讀課件33謝謝！21、要知道對(duì)好事的稱(chēng)頌過(guò)于夸大，也會(huì)招來(lái)人們的反感輕蔑和嫉妒。——培根

22、業(yè)精于勤，荒于嬉；行成于思，毀于隨。——韓愈