单胎妊娠中经阴道宫颈环扎术的疗效和预测因素的临床分析

发布时间：2025-05-01 10:42

　　背景:宫颈机能不全是由宫颈功能或结构缺陷导致宫颈不能支撑到足月妊娠。典型的表现是在孕中晚期无痛的,进行性宫颈扩张,导致胎膜膨出,胎膜早破(PROM),中期流产或早产。其发病率在妊娠人数的0.1%至2%之间,在16至28周内约占习惯性流产的15%。这是早产(PTB)的一个重要因素。每年估计有1300万人早产,超过100万的婴儿死于并发症。虽然在过去的几年里中国的新生儿护理已大大改善,在妊娠28周前出生的婴儿存活率<50%,在幸存的婴儿中发生中度至重度残疾的不占少数。这给母亲和她的家庭在精神及经济上形成负担。因此,避免由宫颈机能不全引起的早产和中期妊娠流产成为产科医生的一大挑战。尽管有争议,经阴道宫颈环扎术在几十年内仍然是治疗宫颈机能不全的主要手段。一些研究表明,经历宫颈环扎术的妊娠期妇女与有同样宫颈机能不全并且进行卧床休息或安胎治疗妇女相比,前者在延长孕周和新生儿的生存率上具有更有利的结局。在这项研究中,我们通过比较选择性和紧急环扎术在延长孕周、并发症及新生儿结局等方面上来评估单胎妊娠中以McDonald术式行经阴道环扎术的有效性并确定影响其预后的预测因素。这些信息可以帮助病人和她的...

【文章页数】：81 页

【学位级别】：硕士

【文章目录】：
中文摘要
abstract
Chapter 1 Literature Review
    1.1 Introduction
    1.2 Incidence and Classification
    1.3 Structure of the Cervix
        1.3.1 Anatomical Structure of the Cervix
        1.3.2 Histological Structure of the Cervix
    1.4 Function of the Cervix
        1.4.1 Composition and Physiological function of Cervical Mucus
        1.4.2 Cervical Changes in Pregnancy and Labour
    1.5 Etiology and Risk factors for Cervical Incompetence
        1.5.1 Cervical incompetence and Congenital cervical dysplasia
        1.5.2 Cervical incompetence and Prenatal exposure to Diethylstilbestrol
        1.5.3 Cervical incompetence and Polycystic ovarian syndrome (PCOS)
        1.5.4 Genetic factors of Cervical Incompetence
        1.5.5 Cervical incompetence and Surgical trauma
        1.5.6 Cervical incompetence and Cervical surgery
        1.5.7 Cervical incompetence and Serum relaxin levels
    1.6 Diagnosis of Cervical Incompetence
        1.6.1 Patient History
        1.6.2 Symptoms
        1.6.3 Physical Examination
        1.6.4 Sonographic Diagnosis
        1.6.5 Diagnostic Tests
    1.7 Management of Cervical Incompetence
        1.7.1 Conservative Observational Management
        1.7.2 Surgical Treatment
    1.8 Cervical Cerclage
        1.8.1 Types of Cervical cerclage
        1.8.2 Indications of Cervical cerclage
        1.8.3 Contraindications to Cerclage insertion
        1.8.4 Complications of Cervical cerclage
        1.8.5 Preoperative Management
        1.8.6 Operative Issues
        1.8.7 Postoperative Care
        1.8.8 Removal of Cerclage
        1.8.9 Prevention of Cervical Incompetence
Chapter 2 Aims and Objectives
    2.1 Hypothesis
    2.2 Aims and Objectives
Chapter 3 Material and Methods
    3.1 Study Design
    3.2 Study Population
        3.2.1 Inclusion Criteria
        3.2.2 Exclusion Criteria
    3.3 Methodology
    3.4 Statistical Analysis
Chapter 4 Results
    4.1 Study Population
    4.2 Neonatal Outcomes
    4.3 Elective and Emergency cerclage
Chapter 5 Discussion
    5.1 Efficacy and Safety of Transvaginal cervical cerclage
    5.2 Predictive Factors of Success and Failure
    5.3 Elective and Emergency cerclage
Chapter 6 Conclusion
References
Supervisor Introduction
Self Introduction
Acknowledgements



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