国际妇产科学杂志

国际妇产科学杂志 ›› 2024, Vol. 51 ›› Issue (5): 552-555.doi: 10.12280/gjfckx.20240452

• 产科生理及产科疾病: 病例报告 • 上一篇    下一篇

失去紧急宫颈环扎术机会药物期待治疗成功分娩一例

刘亚欣, 张蜀宁, 陈晓君, 余奕思, 付帅()   

  1. 516600 广东省汕尾市，中山大学孙逸仙纪念医院深汕中心医院产科（刘亚欣，陈晓君），超声科（余奕思）；中山大学孙逸仙纪念医院产科（张蜀宁，付帅）
  • 收稿日期:2024-05-16 出版日期:2024-10-15 发布日期:2024-10-17
  • 通讯作者: 付帅，E-mail：fush7@mail.sysu.edu.cn
  • 基金资助:
    广东省医学科研基金(B2023179)

Successful Delivery after Pharmacological Expectant Management without the Opportunity for Emergency Cervical Cerclage: A Case Report

LIU Ya-xin, ZHANG Shu-ning, CHEN Xiao-jun, YU Yi-si, FU Shuai()   

  1. Department of Obstetrics (LIU Ya-xin, CHEN Xiao-jun), Department of Ultrasound (YU Yi-si), Shenshan Central Hospital, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei 516600, Guangdong Province, China; Department of Obstetrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China (ZHANG Shu-ning, FU Shuai)
  • Received:2024-05-16 Published:2024-10-15 Online:2024-10-17
  • Contact: FU Shuai, E-mail: fush7@mail.sysu.edu.cn

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摘要：

宫颈机能不全是导致妊娠中期反复流产及早产的一个重要因素，由此引发的早产儿相关疾病或新生儿死亡，不仅严重影响育龄女性身心健康，还影响其家庭生活。报道1例妊娠前曾行宫腔子宫纵隔切开术及宫颈冷刀锥切术，妊娠期未监测宫颈长度，孕24+3周时发现宫口无痛性扩张，羊膜囊突入阴道内，因窥诊和阴道检查均触及不到宫颈边缘而无法实施紧急宫颈环扎术的孕妇，仅采用抗生素、宫缩抑制剂等药物期待治疗至孕29+5周未足月胎膜早破后羊水过少急诊行剖宫产终止妊娠并顺利抱婴回家的临床处置经过，并回顾总结了近年来国内外宫颈机能不全的诊治进展，为临床上此类患者的治疗提供一种新的选择方案。

关键词: 宫颈功能不全, 环扎术, 宫颈, 治疗, 病例报告, 阿托西班

Abstract:

Cervical incompetence is a significant factor leading to recurrent mid-trimester miscarriages and preterm births, resulting in serious complications for preterm infants and neonatal mortality, which can severely impact the physical and mental health of women of childbearing age and their families. This paper reports a case of a pregnant woman who had previously undergone hysteroscopic septum resection and cold knife conization of the cervix. During her pregnancy, cervical length was not monitored, and at 24+3 weeks of gestation, painless cervical dilation was discovered, with the amniotic sac prolapsing into the vagina. Due to the inability to palpate the cervical edge during speculum and vaginal examinations, an emergency cervical cerclage could not be performed. The patient was managed with antibiotics, tocolytics, and other medications for expectant management until preterm premature rupture of membranes (PPROM) occurred at 29+5 weeks, leading to oligohydramnios. An emergency cesarean section was performed, resulting in the successful delivery of a live infant who was eventually discharged home. This case review summarizes the clinical management and highlights recent advancements in the diagnosis and treatment of cervical incompetence, providing a new treatment option for similar cases in clinical practice.

Key words: Uterine cervical incompetence, Cerclage, cervical, Therapy, Case reports, Atosiban