《宫颈机能不全》PPT课件.ppt

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1、宫颈机能不全宫颈机能不全新华医院妇产科：周贇宫颈机能不全定义宫颈机能不全定义宫颈机能不全亦称子宫颈内口闭锁不全、子宫颈口松弛症。宫颈功能不全患者的宫颈含纤维组织、弹性纤维及平滑肌等均较少，或由于宫颈内口纤维组织断裂，峡部括约肌能力降低，使宫颈呈病理性扩张和松弛。它是晚期流产、早产的主要原因之一。据报道在一般人群中宫颈功能不全的发生率为0.3 0.5，而在反复流产妇女中宫颈功能不全的发生率为3 5。病因病因分娩损伤：分娩、手术产时扩张宫颈均引起子宫颈口损伤，如急产、巨大儿、子宫口未开全行臀位牵引术、产钳术等。人工流产时扩张宫颈过快过猛。近年来由于早孕人工流产及中孕引产的增加，创伤性宫颈功能不全的

2、发生率不断上升。宫颈楔形切除术后。子宫颈发育不良。诊断诊断反复中晚期流产、早产史，流产前无先兆症状，胎儿娩出极快，要高度怀疑宫颈机能不全。非孕期宫颈管可无阻力的置入8号宫颈扩张器便可确诊，说明宫颈内口宽度达到0.8cm。B超检查：若宫颈长度3.0cm可提示诊断，2.0cm可确定诊断；宫颈内口宽度1.5cm，羊膜囊向颈管内突出，囊内含有或不含有胎儿部分。宫颈机能不全的治疗宫颈机能不全的治疗在孕14 18周时做一个宫颈环扎手术，以加强子宫颈的支持能力。手术方式：经阴简单宫颈环扎术、改良shirodkar法、经腹宫颈内口环扎术。术后处理：术后取头低臀高30位卧床1周，保持外阴清洁，无渣半流食3天，静

3、脉给予宫缩抑制剂抑制宫缩3天。抗生素预防感染1周。精神紧张者使用镇静剂治疗。宫颈机能不全的治疗宫颈机能不全的治疗球囊法球囊法：适用于急诊宫颈环扎，羊膜囊已突出宫颈外口。据报导，成功率高，能延长孕龄平均达31天（1-117天）。Elective cerclage:obstetric history“Urgent”cerclage:early cervical changesEmergency cerclage:advanced cervical dilatationEmergency cerclage:advanced cervical dilatation中央性前置胎盘：在妊娠晚期子宫下段不断

4、伸展，中央性前置胎盘：在妊娠晚期子宫下段不断伸展，宫颈逐渐成熟和扩张，附着在下段的胎盘不能相应宫颈逐渐成熟和扩张，附着在下段的胎盘不能相应地伸展与宫壁发生错位，以致部分胎盘剥离而出血，地伸展与宫壁发生错位，以致部分胎盘剥离而出血，而采用宫颈环扎术环扎宫颈内口，可阻止子宫下段而采用宫颈环扎术环扎宫颈内口，可阻止子宫下段的伸展及宫口的扩张，胎盘与宫壁间不易发生剥离的伸展及宫口的扩张，胎盘与宫壁间不易发生剥离错位。此外环扎后还可增加子宫壁张力，对已剥离错位。此外环扎后还可增加子宫壁张力，对已剥离的部分胎盘有压迫止血的作用。的部分胎盘有压迫止血的作用。Cervical cerclage does no

5、t improve pregnancy Cervical cerclage does not improve pregnancy outcomes in low-risk women whose cervical outcomes in low-risk women whose cervical lengh(CL)early in the second trimester is no lengh(CL)early in the second trimester is no greater than 25 mm.It remains possible that such greater than

6、 25 mm.It remains possible that such women will benefit from other interventions such as women will benefit from other interventions such as a vaginal pessary or progesterone therapy.a vaginal pessary or progesterone therapy.不同的声音不同的声音cervical resistance index(CRI)the force required cervical resista

7、nce index(CRI)the force required to dilate the cervix to 8 mm.A CRI below 5 lb,or 22 to dilate the cervix to 8 mm.A CRI below 5 lb,or 22 Newtons(N),was taken as an indicator of cervical Newtons(N),was taken as an indicator of cervical weakness.weakness.Although the CRI was not inaccord with the past

8、 Although the CRI was not inaccord with the past history in more than one-third of the present history in more than one-third of the present patients.Measuring the CRI may help to detect patients.Measuring the CRI may help to detect cervical weakness and thereby to decide when cervical weakness and thereby to decide when prophylactic cervical cerclage is appropriate in prophylactic cervical cerclage is appropriate in subsequent pregnancies.subsequent pregnancies.不同的声音不同的声音宫颈环扎手术方法宫颈环扎手术方法