Diagnostic tests should not be used to diagnose
cervical insufficiency.
a. Hysterosalpingography
b. Radiographic imaging of balloon traction on the cervix
Non-surgical treatment
1. Transvaginal cervical cerclage: McDonald procedure and Shirodkar procedure
2. Transabdominal cervical
cerclage: laparotomy,
laparoscopy
1. Cerclage placement may be indicated based on a history of cervical insufficiency, physical examination findings, or a history of preterm birth and certain ultrasonographic findings.
Cerclage for the Management of Cervical Insufficiency
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Cervical insufficiency: definition
The inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester。
Short cervical length has been shown to be a marker of preterm birth in general rather than a specific marker of cervical insufficiency.
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Cervical insufficiency: diagnosis
2. Transvaginal cervical cerclage procedures can not place because of anatomical limitations
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Cervical insufficiency: clinical considerations and recommendations
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Cervical insufficiency: diagnosis
Challenging because of a lack of objective findings
and clear diagnostic criteria.
Diagnosis is based on history
1. Painless cervical dilation and expulsion of the
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Cervical insufficiency: treatment options
Non-surgical treatment
1. Vaginal progesterone 2. Vaginal pessary 3. Activity restriction 4. Bed rest 5. Pelvic rest
pregnancy in the second trimester
2. Without contractions or labor
3. In the absence of other clear pathology
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Cervical insufficiency: diagnosis
Can the identification of cervical shortening by TVS be an ultrasonographic diagnostic marker of cervical insufficiency?
Cervical insufficiency: etiology
Cervical conization LEEP Mechanical dilation Obstetric lacerations Congenital müllerian anomalies Deficiencies in cervical collagen and elastin Utero exposure to diethylstilbestrol And so on.
and
Robotic-assisted
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Cervical insufficiency: treatment options
In which situations should Transabdominal cervical cerclage be considered?
1. Failed transvaginal cervical cerclage procedures history（这个我持保留意见）
பைடு நூலகம்
c. Assessment of the patulous cervix with Hegar or Pratt dilators
d. Balloon elastance test
e. Cervical dilators to calculate a cervical resistance index
Uterine cervix
Absence of the signs and symptoms Second trimester
A short cervical length in the second trimester is not sufficient for the diagnosis.
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2. Cerclage should be limited to pregnancies in the second trimester before fetal viability has been achieved.