2例辅助生殖双胎妊娠宫颈管“U”型扩张保守治疗病例报告

Conservative treatment of cervical "U" type dilation in 2 cases of assisted reproductive twin pregnancy

  • 摘要:
    摘要:背景 双胎妊娠因宫颈机能不全或形态异常(如宫颈管“U”型扩张)易引发早产风险,临床处理存在挑战。目的 探讨双胎妊娠宫颈“U”型扩张的孕妇是否需进行宫颈环扎术,为类似病例的处理提供参考。方法 报道2例在解放军总医院第一医学中心2019年及2023年宫颈管“U”型扩张的双胎妊娠保守治疗的诊疗过程及妊娠结局。结果 病例1:孕妇33岁,孕1产0,孕20+5 周超声示宫颈管缩短3d,宫颈内口闭合段长度约1.5 cm,呈“U”型扩张。2019年5月31日住院,治疗期间嘱孕妇卧床,给予甲硝唑片置阴道后穹隆,给予半量低分子肝素钠预防下肢静脉血栓,盐酸利托君注射液与醋酸阿托西班注射液交替使用抑制宫缩,硫酸镁注射液脑保护、黄体酮软胶囊置阴道后穹窿。于孕37+1 周剖宫产二婴。病例2:孕妇39岁,孕1产0,孕25+1 周超声示宫颈管“U”型扩张,超声提示内口宽约2.3 cm,外口宽约0.5 cm,扩张长度约3.1 cm,偶有宫缩。2024年3月1日住院,治疗期间嘱孕妇卧床,给予硫酸镁注射液脑保护、地塞米松磷酸钠注射液促胎肺成熟、黄体酮软胶囊置阴道后穹窿。于孕36+5 周剖宫产二婴。随访中4个孩子均健康。结论 对于辅助生殖双胎妊娠合并宫颈管“U”型扩张的孕妇,在宫颈外口未完全开放、无感染证据且宫缩可控的情况下,通过多学科综合管理(卧床、宫缩抑制剂、黄体酮支持、抗凝及促胎肺成熟等保守治疗),可有效延长孕周,实现近足月分娩。

     

    Abstract:
    Abstract: Background Twin pregnancies are at risk of preterm birth due to cervical insufficiency or abnormal morphology (such as cervical "U" type dilation), and its clinical management is challenging. Objective To investigate whether cervical cerclage should be performed in pregnant women with "U" type dilated cervix during twin pregnancy, and provide reference for the management of similar cases. Methods The diagnosis and treatment process and pregnancy outcome of conservative treatment of 2 cases of assisted reproductive twin pregnancy with cervical "U" type dilation was reported. Results Case 1: The pregnant woman was 33 years old, with 1 pregnancy and 0 births. At 20+5 weeks of gestation, ultrasound showed that the cervical canal was shortened for 3 days, the length of the closed segment of the internal opening of the cervix was about 1.5 cm, and the internal opening was enlarged in a "U" shape. During hospitalization, the pregnant woman was instructed to stay in bed, metronidazole tablets were placed in the posterior fornix of the vagina, half dose of low molecular weight heparin sodium was given to prevent lower limb vein thrombosis, ritodrine hydrochloride injection and atrosiban acetate injection were alternately used to inhibit uterine contractions. Brain protection of magnesium sulfate injection and progesterone soft capsule were placed in the posterior fornix of the vagina. Two infants were delivered by cesarean section at 37+1 weeks of gestation. Case 2: The pregnant woman was 39 years old, with 1 pregnancy and 0 births. At 25+1 weeks of gestation, the ultrasound showed that the cervical canal was "U" shaped dilation, the ultrasound showed that the width of inner vaginal opening was about 2.3 cm, the width of outer vaginal opening was about 0.5 cm, and the dilation length was about 3.1 cm. During hospitalization, the pregnant woman was instructed to stay in bed, given magnesium sulfate injection for brain protection, dexamethasone sodium phosphate injection for promoting fetal lung maturation, and progesterone soft capsule was placed in the posterior vaginal fornix. Two infants were delivered by cesarean section at 36+5 weeks gestation. Current follow-up showed that all babies were healthy. Conclusion For pregnant women with assisted reproductive twin pregnancy complicated with cervical "U" type dilation, under the condition that the external cervical opening is not completely open, there is no evidence of infection and the contraction is controllable, multidisciplinary comprehensive management (bed rest, uterine contraction inhibitors, progesterone support, anticoagulation and fetal lung maturation and other conservative treatments) can effectively extend the gestational week and achieve near-term delivery.

     

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