Risk factors for cervical insufficiency
Previous history of preterm birth or miscarriage in older months;
multiple pregnancies such as twins and triplets;
Gynecologic mechanical surgical trauma: history of surgical treatment of cervical conization or circumferential resection; endocervical mediastinotomy; trachelectomy or wide excision; repeated mechanical dilation of the cervical canal;
Cervical laceration caused by acute labor and other causes of cervical internal orifice tissue weakness or loss, and eventually pathological dilation and relaxation;
The interval between pregnancies is too short to be less than 12 months (especially if the first child is macrophysical);
Pregnant women who are too young≤ 17 years old or old.
The cervix is "loose" and needs to be tied tightly
Cervical insufficiency often requires surgery or medication to avoid miscarriage and preterm birth, and cervical cerclage is the most commonly used and effective. To put it simply, it is to use a special braided thread to tie the cervix as close as possible to the inner opening of the cervix, and then disassemble the silk thread at 38 weeks of pregnancy. Prompt emergency cervical cerclage is a powerful way to save an immature baby. It is worth mentioning that the success rate of emergency cervical cerclage is significantly lower than that of prophylactic cervical cerclage, and prevention is greater than emergency remediation. Therefore, mothers with high-risk factors must follow up with the doctor's instructions, and if necessary, "tie the cervix tightly" in advance.
Obstetricians generally combine medical history, physical examination, and comprehensive assessment of gestational age to formulate a personalized diagnosis and treatment plan. In general, cervical cerclage is required in the following 3 situations:
1. History of miscarriage in the second trimester with one or more painless uterine dilation;
2. A history of late miscarriage or preterm birth, accompanied by cervical shortening by ultrasound;
3. The pregnancy examination found that the uterine opening was dilated.
If the pregnant mother or sister who is trying to get pregnant, it is also recommended to come to the outpatient clinic for further consultation and evaluation in the following situations, so as to prepare in advance to avoid critical situations:
1. Have had a miscarriage or premature birth of more than 14 weeks of gestation;
2. Have had preterm birth or premature water break (before 37 weeks);
3. Cervical shortening was found by ultrasound during this or last pregnancy;
4. Twin or multiple pregnancies (especially emphasized), assisted reproduction, gestational diabetes, hypertension, autoimmune diseases, etc.
5. Have undergone cervical surgery (LEEP knife cervical conization, circumcision, cervical laser surgery, cervical microwave surgery, etc.);
6. Have undergone cervical cerclage surgery;
7. Lower abdominal distension with or without obvious cause in the first and second trimesters with or without a significant increase in vaginal discharge;
8. History of two or more uterine surgeries, such as induced abortion, hysteroscopy, etc.;
9. Uterine malformations (such as unicornonuate uterus, mediastinal uterus, etc.);
10. Women of childbearing age with high-risk factors for preterm birth need preconception counseling.
Expert Profile
Yuan-hsien
Deputy Chief Physician
Graduate
Graduated from the School of Medicine of Yangzhou University, he has been engaged in clinical work for more than ten years, and is good at the diagnosis and treatment and management of obstetric-related complications and comorbidities (including cervical insufficiency, gestational hypertension, gestational diabetes, fetal growth restriction, twin pregnancy, preterm birth, scarred uterus, etc.), prenatal diagnosis of fetal diseases, eugenic genetic counseling, and perinatal health care. In 2022, he studied in Nanjing Drum Tower Hospital, and published many papers at or above the provincial level during his work.
Characters|袁娌咏
Editor: Lee Jong-yu
Audit|Liya Lin
Editor|Ma Xinmei