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首页> 外文期刊>BJOG: an international journal of obstetrics and gynaecology >Commentary on 'Sequential cervical length screening in pregnancies after LLETZ conisation: A retrospective analysis'
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Commentary on 'Sequential cervical length screening in pregnancies after LLETZ conisation: A retrospective analysis'

机译：关于“ LLETZ锥切后妊娠的顺序宫颈长度筛查：回顾性分析”的评论

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Although emphasised by Pils et al., the use of cervical sonography to predict the risk of preterm birth or to identify candidates for treatment with cerclage or progesterone is not the principal contribution of cervical imaging. Rather, the importance of cervical ultrasound is that it has provided the opportunity to observe the parturitional process at the cervix and decidual-membrane interface. These observations have overturned previous paradigms that emphasised myome-trial activity, membrane rupture, and early cervical effacement as independent pathways to preterm birth. The association of a short cervix with an increased risk of preterm birth was initially interpreted in that paradigm as evidence of a continuum of competence, to which LLETZ was a surgical contributor, and for which cerclage, a surgical cure, was prescribed. After more than a decade cf unsuccessful attempts to find a combination of cervical length threshold and reproductive history that could distinguish 'cervical insufficiency' from 'preterm labour', the results of two landmark studies produced a revelation: a medical therapy, progesterone, was shown to be effective for a short cervix (Fonseca et al, N Engl J Med 2007;357:462-469), whereas surgical treatment helped women with the shortest cervical length, of less than 15 mm, where a greater benefit would be expected when the cervix was 15-25 mm (Owen et al, Am J Obstet Gynecol 2009;201:375.el-375.e8). These studies have made it clear that, with some exceptions, a short cervix is evidence of parturition in progress, a process that is more biochemical than biophysical, and that in the most severe cases is evident well before the now outdated 20-week delineation between 'miscarriage' and 'preterm labor'.
机译：尽管由Pils等人强调，使用宫颈超声检查来预测早产的风险或确定使用环扎或孕酮治疗的候选人并不是宫颈成像的主要贡献。相反，宫颈超声的重要性在于它提供了观察子宫颈和蜕膜膜界面分娩过程的机会。这些观察结果推翻了以前的范例，这些范例强调了子宫肌瘤的活动，膜破裂和子宫颈早期脱落是早产的独立途径。在该范例中，最初将短宫颈与早产风险增加相关联，证明其具有连续的能力，LLETZ是外科手术的贡献者，并开具了环扎术（手术治愈）。经过十多年的不成功尝试，发现无法将宫颈长度阈值和生殖史相结合以区分“子宫颈功能不全”和“早产”，两项里程碑式研究的结果产生了启示：显示了一种药物黄体酮的治疗方法可以有效治疗短宫颈（Fonseca等人，N Engl J Med 2007; 357：462-469），而外科治疗可帮助宫颈长度最短（小于15毫米）的女性获得更大的收益。子宫颈为15-25mm（Owen等，Am J Obstet Gynecol 2009; 201：375.el-375.e8）。这些研究已经清楚地表明，除某些例外情况，子宫颈短是分娩过程的证据，这一过程比生化过程更具生物化学性，并且在最严重的情况下，明显早于现在已经过时的20周界限。 “流产”和“早产”。

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