Rozenberg P, Goffinet F, Hessabi M
INSERM U.149, Paris.
Bull Acad Natl Med. 1999;183(3):589-99; discussion 599-600.
Our aim was to compare the Bishop score, FNf assays, and the sonographic measurement of cervical length, in order to assess the best marker for time until spontaneous labor at term and risk of cesarean, especially for lack of progress of dilatation. This prospective study included 128 singleton vertex pregnancies with no clinical evidence of membrane rupture or regular contractions and a prenatal consultation between 39 weeks 4 days and 40 weeks 3 days. We successively assayed FNf, determine the Bishop scored, and measured cervical length by transvaginal ultrasound. The end points were the percentage of patients with a spontaneous onset of labor in the week following these tests and the type of delivery. The spontaneous onset of labor within a 7-day period was closely associated with a Bishop score > or = 6 and especially with a cervical length < or = 26 mm, but not with a positive FNf assay. On the other hand, vaginal delivery was significantly associated with the fibronectin assay but not with either the Bishop score or cervical length. Ultrasound measurement of cervical length and the fetal fibronectin assay provide different physiological data useful for different purposes: cervical length is more valuable than the Bishop score for predicting the onset of spontaneous labor within 7 days (when these assessments are performed close to term) and the FNf assay is very useful for evaluating the risk of cesarean.
我们的目的是比较 Bishop 评分、胎儿纤维连接蛋白（FNf）检测以及宫颈长度的超声测量，以评估足月自然临产时间及剖宫产风险的最佳指标，尤其是针对宫颈扩张无进展的情况。这项前瞻性研究纳入了 128 例单胎头位妊娠，这些孕妇无胎膜破裂或规律宫缩的临床证据，且孕周在 39 周 4 天至 40 周 3 天之间进行了产前检查。我们依次检测了 FNf，确定了 Bishop 评分，并通过经阴道超声测量了宫颈长度。终点指标为这些检查后一周内自然临产患者的百分比以及分娩方式。7 天内自然临产与 Bishop 评分≥6 密切相关，尤其与宫颈长度≤26mm 相关，但与 FNf 检测阳性无关。另一方面，阴道分娩与纤维连接蛋白检测显著相关，但与 Bishop 评分或宫颈长度均无关。宫颈长度的超声测量和胎儿纤维连接蛋白检测提供了不同的生理数据，适用于不同目的：在接近足月进行这些评估时，宫颈长度在预测 7 天内自然临产方面比 Bishop 评分更有价值，而 FNf 检测在评估剖宫产风险方面非常有用。
