Yang J H, Kuhlman K, Daly S, Berghella V
Department of Obstetrics and Gynecology, Samsung Cheil Hospital, Korea.
Ultrasound Obstet Gynecol. 2000 Apr;15(4):288-91. doi: 10.1046/j.1469-0705.2000.00087.x.
To determine the predictive value of sonographic cervical length and of funneling for spontaneous preterm delivery (PTD) in twin pregnancies under 26 weeks' gestation.
Women with twin pregnancies were studied prospectively with transvaginal or translabial ultrasound of the cervix from 18 to 26 weeks' gestation. Exclusion criteria were: signs of preterm labor, prophylactic cervical cerclage, placenta previa, or severe congenital fetal anomaly. The primary outcome was spontaneous preterm birth at < 35 weeks' gestation.
Sixty-five twin pregnancies were analyzed, of which 23% (15/65) delivered preterm. Cervical ultrasound examination was performed by 22 weeks' gestation in 75% and by 24 weeks' gestation in 91% of women. Cervical length < or = 25 mm and < or = 30 mm was associated with sensitivities of 27% and 53%, respectively, and with 67% and 62% rates of PTD, respectively (R.R. 4.6, C.I. 2.0-10.3 and R.R. 3.6, C.I. 1.6-7.8, respectively). A cervical length > 35 mm was associated with only a 4% rate of PTD (R.R 0.13; C.I. 0.02-0.93). Of 10 women (15%) with any cervical funneling, 70% delivered preterm, all under 32 weeks' gestation. By logistic regression analysis, both short cervix < or = 30 mm and any funneling were strongly predictive of PTD.
Both cervical length < or = 30 mm and cervical funneling in twin pregnancies under 26 weeks' gestation are independently and strongly associated with high risk for preterm birth. A long cervix, of length > 35 mm, is associated with very low risk (4%) for preterm birth.
确定妊娠26周以下双胎妊娠中超声测量宫颈长度及宫颈内口漏斗形成对自然早产的预测价值。
对双胎妊娠妇女在妊娠18至26周期间进行经阴道或经阴唇超声检查宫颈情况。排除标准为：早产迹象、预防性宫颈环扎术、前置胎盘或严重先天性胎儿异常。主要结局为妊娠35周前自然早产。
分析了65例双胎妊娠，其中23%（15/65）早产。75%的妇女在妊娠22周时进行了宫颈超声检查，91%的妇女在妊娠24周时进行了检查。宫颈长度≤25mm和≤30mm时，自然早产的敏感性分别为27%和53%，早产发生率分别为67%和62%（相对危险度分别为4.6，可信区间2.0 - 10.3；相对危险度3.6，可信区间1.6 - 7.8）。宫颈长度>35mm时，早产发生率仅为4%（相对危险度0.13；可信区间0.02 - 0.93）。10例（15%）有任何宫颈内口漏斗形成的妇女中，70%早产，均在妊娠32周前。通过逻辑回归分析，宫颈长度≤30mm和任何宫颈内口漏斗形成均强烈预测自然早产。
妊娠26周以下双胎妊娠中，宫颈长度≤30mm及宫颈内口漏斗形成均与早产高风险独立且密切相关。宫颈长度>35mm与极低的早产风险（4%）相关。
