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02 February 2014, Volume 30 Issue 2 Previous Issue    Next Issue

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The etiology of cervical incompetence CHEN Jing,DING Wen-jing,ZHU Xiao-lu,TENG Yin-cheng 2014, 30(2): 85-88.  Abstract ( )   PDF (847KB) ( )   Abstract:The pathogenesis of cervical insufficiency is still unclear so far.Collagen fibers play great role in maintaining normal function of cervix. There are congenital and acquired cervical insufficiencies.The congenital cervical insufficiency results from the anatomical anomaly of tissues, the lack of cervical collagen and the exposure to diethylstilbestrol while the acquired cervical insufficiency is related to cervical trauma and biochemical influence. 

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Partial trachelectomy and cervical insufficiency. DAI Lan,DI Wen 2014, 30(2): 88-90.  Abstract ( )   PDF (833KB) ( )   Abstract:Partial trachelectomy is a fertility-preserving procedure for patients with cervical intraepithelial neoplasia and early cervical cancer. However, the surgical procedure may change the shape of the cervix and cause cervical insufficiency, which can increase the risk of poor obstetric outcomes. This paper focused on the relationship between partial trachelectomy and cervical insufficiency.

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The progestational diagnostic methods of cervical incompetence WANG Xiao-yi, CHEN Dun-jin. 2014, 30(2): 90-93.  Abstract ( )   PDF (850KB) ( )   Abstract:Cervical incompetence is the major cause of perinatal morbidity and mortality rate due to uterine factors, the occurrence rate is about 0.1%－1%. Pregnancy history such as abortion and preterm birth history, uterine malformation and cervical operation history is critical to the diagnosis of cervical incompetence; Next is imaging examination, the most commonly used method is vaginal ultrasound, hysterosalpingography under X-ray and magnetic resonance imaging has been less used; Passage of dilator through the internal os and the Foley traction test has some subjectivity at the time of diagnosis, and it has the risk of intrauterine infection, so they have been less used in clinical hospital;Laparoscopy and hysteroscopy examination are rarely used because of the technology and equipment constraints; In addition, cervical incompetence may be related to gene expression, but has not yet been confirmed. Combine the history with auxiliary examination to diagnose earlier and give proper treatment, we can avoid pregnancy loss and premature birth to a certain extent, and improve the pregnancy outcome. 

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Diagnosis and evaluation of cervical incompetence during pregnancy. ZHANG Xiang-li 2014, 30(2): 93-96.  Abstract ( )   PDF (854KB) ( )   Abstract：The diagnosis of cervical incompetence（CIC）during pregnancy mainly is based both on clinical findings (cervical characteristics, ultrasound studies)and on the previous history of the patient. Diagnosis of cervical incompetence is usually limited in single pregnancy. Using historic factors alone, cervical insufficiency is defined as painless cervical dilatation leading to recurrent second trimester pregnancy losses/births（at least twice） before 28 weeks of gestation have occurred. Cervical insufficiency is diagnosed by TVU cervical length<25 mm and/or advanced cervical changes on physical examination before 24 weeks of gestation in primigravidas or in multigravidas（without multiple prior pregnancy losses）with either：one or more prior pregnancy losses or preterm births at 14 to 36 weeks,and/or other significant risk factors for cervical insufficiency.

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Conservative treatment for suspicious cervical insufficiency.  SHI Chun-yan. 2014, 30(2): 96-99.  Abstract ( )   PDF (853KB) ( )   Abstract:A widely agreed-upon definition for the diagnosis of cervical insufficiency has yet to be achieved. The advent of ultrasonic cervical length measurement has added an additional criterion to the definition of cervical insufficiency. During the midtrimester of pregnancy the cervical length shorter than 25 mm by vaginal sonography without uterine contraction is suspicious of cervical insufficiency. Cerclage indicated by ultrasound for women with singleton gestations, no prior preterm birth history is no significant benefit for reduction of the preterm birth rate, however vaginal progesterone, either 90-mg gel or 200-mg suppository, is associated with reduction in PTB and perinatal morbidity and mortality when the CL<20mm. Either vaginal progesterone or cerclage or cervical pessary are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the midtrimester, singleton gestation, and previous preterm birth history. The selection of the optimal treatment may depend upon adverse events, cost and patient/clinician preferences.

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Transvaginal cervicoisthmic cerclage before pregnancy for the treatment of cervical incompetency.  ZHANG Song-Ying，JIN Xiao-ying,XU Wen-zhi. 2014, 30(2): 99-101.  Abstract ( )   PDF (835KB) ( )   Abstract:Cervical cerclage is the most effective method for the treatment of cervical incompetence at present. Shirodkar and McDonald's transvaginal cervical cerclage as well as Benson and Durfee's transabdominal cervical cerclage is traditional ways of operation. The former has a lower placement and the effect is less ideal. The latter has a confirmed effect but it increases the surgical trauma and risk for two times into the abdomen. In this paper, the author has performed 123 cases by modified transvaginal cervicoisthmic cerclage before pregnancy, and found that the operation is convenient, ideal, safety and worth promoting. 

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Laparoscopic cervicoisthmic cerclage. YAO Shu-zhong,JIANG Hong-ye. 2014, 30(2): 102-105.  Abstract ( )   PDF (843KB) ( )   Abstract:Cervicoisthmic cerclage is the main procedure for cervical incompetence. Laparoscopic cervicoisthmic cerclage is an alternative and effective method for those who have the history of transvaginal approach or abnormal cervical anatomy. Laparoscopic cervicoisthmic cerclage can be carried out before pregnancy or during first trimester pregnancy.For women who have a fetal demise in the second trimester, vaginal delivery can still be achieved after cutting or removal of Mersilene tape through laparotomy or laparoscopy. Cesarean section should be performed for women with term pregnancy. Laparoscopic cervicoisthmic cerclage is one of the most effective procedures for the treatment of cervical incompetence. However, there is still lack of strong evidences from randomized clinical trials, especially from domestic research;to support that laparoscopic cervicoisthmic cerclage should be the standard procedure in the treatment of cervical incompetence.

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Cervical cerclage treating cervical incompetence in pregnancy. WANG Xiao-fei,ZHAO Ai-min. 2014, 30(2): 105-108.  Abstract ( )   PDF (900KB) ( )   Abstract：Cervical incompetence is one of the main reasons led to recurrent late abortion and premature birth.Cervical cerclage is considered as the most effective way of treating cervical incompetence. It can significantly improve the success rate of pregnancy and prolonged gestation. This article attempts to review the relevant studies regarding cervical cerclage for the treatment of cervical incompetence.

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Indications and notices of emergent cerclage.  ZHU Li-qiong,ZHANG Jian-ping.  ZHU Li-qiong,ZHANG Jian-ping. 2014, 30(2): 108-110.  Abstract ( )   PDF (835KB) ( )   Abstract：Emergent cerclage may be defined as that performed in the setting of advanced cervical dilation with bulging membranes. It's an emergency operation that can save normal but immature fetus. Previous studies have indicated that the success rate of operation was 72.72%. That means emergent cerclage is a good remedy when the treatment of cervical incompetence is not timely. However, it may have serious complications if we can't grasp the opportunity and master the indications of the operation. So grasp the operation indications strictly, pay more attention in operative procedure and give good postoperative monitoring can improve the success rate of emergent cerclage.

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The management of the pregnant women after insertion of cervical cerclage. Mei Ling,LIU Xing-hui. 2014, 30(2): 110-112.  Abstract ( )   PDF (835KB) ( )   Abstract:Cervical cerclage has been widely used to prevent preterm labor in patients with cervical incompetence.This article will focus on the important issues about the management of the pregnant women after insertion of cervical cerclage.

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Expression  of large conductance Ca2+ activated K+ channel in postpartum hemorrhage.  YAN Jian-ying, LIAO Qiu-ping, LIU Qing-min, XU Rong-li,HUANG Xiao-yan,LIN Shun-he,CHEN Wen-zhen,LUO Mei-yu. 2014, 30(2): 113-117.  Abstract ( )   PDF (851KB) ( )   Abstract:Objective To detect the expression of large conductance Ca2+ activated K+ channel(BKCa) in myometrium in patients with postpartum hemorrhage(PPH).Methods The levels of contractile frequency, amplitude and contraction of myometrium were detected by RM6240 biological experimental system; the BKCa(α, β subunit) protein expression levels in myometrium were detected by Western blot; the BKCa(α, β subunit) mRNA expression levels in myometrium were detected by real-time fluorescent quantitative reverse transcription-polymerase chain reaction for women with PPH caused by uterine atony(study group, n=30) and normal uterine smooth muscle contraction(control group, n=30).Results (1) In study group, the levels of myometrium contractile frequency, amplitude and contraction were lower than that of the controls(P<0.05). (2) In study group, BKCa (α, β subunit) protein and mRNA expression in myometrium were significantly higher than that of control group(P<0.05). (3) Both groups, the level of myometrium contraction was negatively related to BKCa (α, β subunit) protein, BKCa (α, β subunit) mRNA level in myometrium.Conclusion Increased BKCa expression in myometrium may be involved in the pathogenesis of PPH caused by uterine atony.

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Differentially expressions of miR-134 and miR-17-92 clusters and ovarian cancer paclitaxel resistance.  WANG Dan-dan, WANG Min, SHUANG Ting,SHI Cong, ZHANG Ping, TAO Tao,SHI Chun-xue, WU Jian-lei. 2014, 30(2): 118-122.  Abstract ( )   PDF (931KB) ( )   Abstract:Objective To detect the differentially miRNA expression in paclitaxel sensitive and chemoresistant ovarian cancer cell lines, and to explore the molecular mechanism of drug resistance of ovarian cancer.  Methods The expression profile of miRNA were detected with miRNA microarray chip hybridization and the compared array results were further validated by Real-time PCR and Western Blot. Potential miRNA targets were predicted by bioinformatic software. Results Compared with SKOV3 cell line, miR17－92 gene cluster with high expression while miRNA134 cluster with low expression was found in SKOV3-TR30 cells. It can be predicted by bioinformatic software that miR17－92 gene cluster has 30 target genes such as BIM，PTEN，ABCA1，C10orf46，CD4, while miRNA134 cluster has 128 target genes such as MRP1/ABCC1. Western Blot showed that compared with SKOV3 cells, BIM expression was decreased in SKOV3-TR30 cells,while c-Myc was in high expression in SKOV3-TR30 cells.Conclusion The differentially miRNA expression profiles in SKOV3 and SKOV3-TR30 can be obtained by miRNA microarray chip technology. MiR-17－92 cluster and miR-134 cluster may be involved in drug resistance of ovarian cancer by regulating their target genes,which provide a theoretical basis for the study of ovarian cancer chemoresistance.