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经阴道超声评估宫颈与预测自发性早产

Author
Vincenzo Berghella, MD
Section Editors
Charles J Lockwood, MD, MHCM
Deborah Levine, MD
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
熊奕, 主任医师

引言

妊娠期宫颈超声成像促进了我们对于妊娠期宫颈功能的理解。宫颈管消退是分娩过程的第一步，至少比临产早4-8周。宫颈管消退首先发生在宫颈内口，朝尾侧方向依次消退，所以经超声可见，但通过指检或视检并不一定能发现。随着妊娠中期宫颈长度缩短，自发性早产的风险增加[1-5]，特别是当中期妊娠早期发生宫颈管消退时[6]。

尽管短宫颈可被视为分娩过程已开始的证据，但早产宫颈管缩短的原因常不明确。已提出的原因包括生物变异、隐匿性子宫活动、子宫过度扩张、先天性或获得性宫颈功能不全、蜕膜出血，以及感染或炎症。短宫颈和宫颈功能不全的危险因素将单独讨论。 (参见“宫颈机能不全”)

技术

经阴道超声(transvaginal ultrasound, TVU)检查是评估宫颈的重复性最好和最可靠的技术[7]。如果在妊娠25周以前行经腹超声检查怀疑有短宫颈，则应行TVU检查以获得宫颈长度的最佳估测。宫颈的经腹超声图像的重复性较差，因此不应用于临床处理[8-10]。

与TVU相比，经会阴超声更困难、重复性更差，且效度更差[11,12]。

时机 — 妊娠14周前测量宫颈长度的临床价值有限[13,14]。然而，对于某些特别高危的妊娠，例如曾发生妊娠中期胎儿丢失和/或行大的(或多次)宫颈锥切活检，可早在妊娠10-13周即观察到宫颈缩短，这时的宫颈缩短属于异常，会增加中期妊娠胎儿丢失的风险[13]。在妊娠约14周时，宫颈正常情况下与子宫下段有明显区别，这时宫颈长度测量可能具有可重复性。

                    

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-01.
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