*For medical professionals only
Detailed explanation of cervical cerclage
As we all know, multiple births are almost all born on the same day, but not long ago, the quadruplets of a pregnant woman in Shandong were born in 3 times in 10 days.
According to Ma Yuyan, chief physician of the second ward of the maternity ward of Qilu Hospital of Shandong University, when the pregnant woman first arrived, she already had symptoms of threatened miscarriage and was diagnosed with cervical insufficiency. In order to allow the fetus to spend more time in the mother's womb, doctors performed a cervical cerclage for her.
On 22 March, the pregnant woman gave birth to a fetus with a gestational age of 25 weeks + 6 days. After 4 days, another baby is born. On the evening of 19 April, after a cesarean section, the two fetuses born at the latest were 27 weeks + 2 days pregnant.
Image source Weibo
The phenomenon of multiple births on different dates is medically called delayed interval delivery.
In this case, cervical cerclage was mainly used for delayed interval delivery.
What is cervical cerclage?
Cervical cerclage refers to surgery in which women with a short history of cervical disease reinforce their cervix with sutures or synthetic tape during pregnancy.
When pregnant women are born or acquired due to congenital or acquired abnormalities in the morphology, structure and function of the internal cervical mouth, in the non-childbirth state, the cervical pathological relaxation and expansion, can not maintain pregnancy to term, cervical cerclage can prolong the duration of pregnancy and improve the survival rate of newborns.
Graph source network
In recent years, under the influence of a variety of factors, the incidence of cervical insufficiency in women of childbearing age has gradually increased, and cervical insufficiency is a risk factor for late miscarriage and preterm birth. Studies have shown that the incidence of late miscarriage and preterm birth in women of childbearing age with cervical insufficiency is 1 to 3 times or higher in healthy women, and cervical cerclage is the main method of treating cervical insufficiency.
Especially for women who have a history of late spontaneous abortion or preterm birth, before pregnancy, they should go to the hospital to check the elasticity of the cervix, because the possibility of spontaneous abortion and recurrence of premature birth is about 15%-30%.
Under what circumstances,
Need a cervical cerclage?
1. Miscarriage and preterm birth caused by cervical insufficiency.
2. Multiple pregnancies: Excessive uterine swelling caused by multiple pregnancies is one of the main causes of premature rupture of membranes and premature birth. Cervical cerclage can prolong the gestational age and significantly improve the fetal survival rate of multiple pregnancies.
Indications for cervical cerclage are indications for history, transvaginal ultrasound, and physical examination.
1. Indications of medical history: fetal loss of painless cervical dilation in the middle and third trimester of pregnancy 1 or more times in the past, excluding factors of labor and placental abruption.
Transvaginal cerclage is usually performed at 12 to 14 weeks' gestation, and laparoscopic cerclage can be performed before pregnancy or at 7 to 10 weeks' gestation. The later the gestational age, the more difficult the operation and the lower the success rate. Do it 1 or 4 weeks before the last miscarriage or preterm gestational week.
2. Transvaginal ultrasound indications: must be combined with a history of miscarriage, preterm birth, second trimester, monitoring of cervical canal length ≤ 25 mm for the indication of cerclage.
3. Indications for physical examination: vaginal examination in the middle and late pregnancies, finding painless cervical dilation, fetal sac protruding in the vagina, excluding infection, placental abruption and other factors, can only be performed emergency cervical cerclage. The success rate is lower than that of prophylactic cycloligature, which is difficult, and there is a fetal cyst bulging out of the uterine opening, which needs to be pushed back with a wet yarn and then sutured, but the fetal membrane is easily peeled off or ruptured. According to studies, the success rate of emergency cervical cerclage is 72.72%.
The 4 twins in the news, because there is no previous history of miscarriage and premature birth, the symptoms of preterm birth are only manifested after 12 weeks of pregnancy, when the fetus becomes larger and there is pressure on the cervix, and it is difficult to find cervical insufficiency during non-pregnancy, so emergency circumcision is used.
Under what circumstances is cervical cerclage not appropriate?
Cervical cerclage is not suitable for everyone:
1. Vaginal bleeding, uterine contractions and rupture of membranes are contraindicated in surgery.
2. Fetal malformations, placental abruption, amnioticitis, etc.
In addition, cervical cerclage has complications: inflammation, rupture of membranes, damage to membranes, etc.
Can I give birth naturally after cervical cerclage?
Childbirth can be natural.
Post-cerclage pregnancies, as in normal pregnancies, have vaginal or caesarean sections, which are determined based on the obstetric indications assessed at the time.
Transvaginal cervical rings are implicated in labor, and once contractions occur, the treatment is ineffective, and the sutures should be removed in time to avoid cervical lacerations or heavy bleeding. If there is no contractions, it is removed at 37 to 38 weeks' gestation.
If you are having a transabdominal cervical cerclage, removal is recommended during caesarean section or optional retention in case of future pregnancy to prevent another miscarriage or premature birth.
What should I pay attention to before and after cervical cerclage?
1. 3 to 5 days before surgery, take the hip high head low lying position, during the operation, after the operation with β receptor blocker or magnesium sulfate intravenous drip to inhibit uterine contractions.
2. If there is vaginal inflammation, it should be treated.
3. After 3 days of bed rest after surgery, daily activities can be resumed, but not too intense. After that, short-term use of uterine relaxants is continued, and antibiotics can be used to prevent infection.
4. Keep the stool unobstructed, eat a balanced diet, and prohibit spicy stimulation. If abdominal pain bleeds, or vaginal fluid, prompt medical attention should be made.
bibliography:
[1] Hou Yue,Qiao Pet. Assisted Reproductive Technologies for Pregnancy and Cervical Insufficiency[J/CD].Chinese Journal of Obstetric Emergency Electronics,2019,8(3):151-154.DOI:10.3877/cma.j.issn.2095-3259.2019.03.006.
Zheng Xiuqiong, Xie Xi, Liu Chaobin, et al. Clinical value of cervical cerclage in the treatment of cervical insufficiency during pregnancy[J]. Chinese Journal of Obstetrics and Gynecology,2017,18(2):170-172.
Wang Fan. Progress in the diagnosis and treatment of cervical insufficiency by cervical cerclage[J]. Continuing Medical Education,2016,30(9):98-101.
LI Xue, ZHANG Hong. Cervical insufficiency cerclage and preterm birth[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2018, 34(2):5.
Source: Medical Community Obstetrics and Gynecology Channel
Author: Little Banana
This article was reviewed: Bao Yirong Shanghai First Maternal and Infant Health Hospital
Editor-in-charge: Tian Wei
Proofreader: Zang Hengjia