SHORT CERVIX – WHAT NOW? Faris Mujezinović
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Volume:
78
Journal Article
Peer reviewed
Open access
Background: It is possible to predict preterm delivery (PD) before 34 weeks by ultrasound measurement of uterine cervical length (CL). This is the reason why this screening method is more frequently ...used in clinical practice. Methods: I extracted from PubMed database Crane’s sistematic review and articles about association of CL with PD and instructions what is necessary to take into consideration and what to do in case of a short cervix. Results: Majority of studies suggested CL of 25 mm as a cut-off point for selecting pregnancy as high risk for PD. Minority of studies also used 15 mm as a cut-off point. This inconsistency in selecting an unique cut-off point, as some authors showed, is a result of ignoring gestational age when measurement of CL is made. CL is usually measured until 24 weeks of pregnancy and value of US measurement of CL made later in pregnancy or role of follow-up measure- ments are still unclear. In cases with threatened preterm labour where CL is measured there was 66 % reduction of unnecessary tocolysis. US measurement of CL is of a little value if there is a progressive dilatation of cervix (Bishop score > 6). Shirodkar cerclage in women with short cervix does not reduce the risk for PD. Vaginal progesteron causes a 50 % decrease of incidence of PD in women with short cervix (CL < 15 mm). We do not know which form of vaginal progesteron is most effective. Progesteron is uneffective in women with PD in previous pregnancy and CL > 25 mm. Conclusions: US measurement of CL becomes reliable criteria for detecting pregnancies with increased risk for PD before 34 weeks of pregnancy. It enables individual risk calculation for PD with consideration of other risk factors.
Background: To obtain a complete diagnosis of preinvasive cervical lesions, the results of cytology, col- poscopy and histological biopsy are needed. Low-grade lesions (LG-SIL, CIN 1) should be ...managed conservatively because such lesions can regress. Treatment is suggested if the abnormality persists for 2 years or if the lesion worsens in grade or size. High-grade lesions (HG-SIL, CIN 2 and 3) are managed by different treatment modalities. Ablative modalities include cryocautery, electrocoagulation diathermy and laser ablation. For ablative treat- ment only ectocervical lesions with entirely visible squamocolumnar junction visible are suitable. Small localized lesions of CIN 1 and 2 may be treated by cryocautery or electroco- agulation diathermy. Lesions entering the cervical canal cannot be destroyed with certainty. Laser destroys the tissue by evaporation and coagulation, and is useful if the dysplastic areas extend into the vaginal fornices. Excision modalities including loop diathermy excision, cold-knife conization, laser cone biopsy and hysterectomy provide specimens for histology. Loop diathermy excision is currently the most common treatment modality. Cold-knife conization is performed with a scalpel. The cone can be broad and shallow or narrow and deep, depending on the location and the size of the lesion. Laser cone biopsy is relatively costly and time-consuming. Histopathology aims to assess the nature of the lesion and to determine whether it has been removed completely. Conclusions: Treatment of preinvasive lesions is not completely harmless for the patient. Complications include hemorrhage, cervical stenosis or incomplete excision. Hysterectomy should be con- sidered for a patient with CIN suffering from menorrhagia, uterine prolapse or leiomyomas as well as in cases of adenocarcinoma in situ, when the reproductive function has been completed.
Rak materničnega vratu lahko prizadene ženske v rodnem obdobju. V stadiju IB1 je mogoče pri zdravljenju rakave bolezni ohraniti rodno funkcijo ženske z radikalno trahelektomijo in odstranitvijo ...medeničnih bezgavk.To je operacija, pri kateri se odstrani maternični vrat in paracervikalno tkivo (parametriji) v kombinaciji z odstranitvijo medeničnih bezgavk, telo maternice pa se ohrani. Predstavljamo primer 32-letne nulipare z rakom materničnega vratu stadija 1B1. Bolnica je bila zdravljena radikalno z ohranitvijo rodne funkcije in je po zdravljenju rodila donošenega otroka.
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