Mercer B M, Goldenberg R L, Meis P J, Moawad A H, Shellhaas C, Das A, Menard M K, Caritis S N, Thurnau G R, Dombrowski M P, Miodovnik M, Roberts J M, McNellis D
Am J Obstet Gynecol. 2000 Sep;183(3):738-45. doi: 10.1067/mob.2000.106766.
Our objective was to determine the relative importance of demographic characteristics, clinical risk factors, and ancillary screening tests in the prediction of preterm birth as a result of premature rupture of membranes.
A total of 2929 women were evaluated in 10 centers at 23 to 24 weeks' gestation. Demographic and clinical characteristics were ascertained. Cervicovaginal fetal fibronectin and bacterial vaginosis were evaluated. Cervical length was measured by vaginal ultrasonography. Patients were evaluated for spontaneous preterm birth caused by preterm premature rupture of membranes at <37 and <35 weeks' gestation. Multivariate analyses were performed separately for nulliparous women and multiparous women.
Premature rupture of membranes at <37 weeks' gestation complicated 4.5% of pregnancies, accounting for 32.6% of preterm births. Univariate analysis revealed low body mass index, pulmonary disease, contractions within 2 weeks, short cervix (</=25 mm), positive results of fetal fibronectin screening, bacterial vaginosis, and a previous preterm birth caused by premature rupture of membranes (in multiparous women) to be significantly associated with preterm birth caused by premature rupture of membranes in the current gestation. Short cervix, previous preterm birth caused by premature rupture of membranes in multiparous women, and presence of fetal fibronectin were the strongest predictors for both preterm birth caused by premature rupture of membranes at <37 and <35 weeks' gestation. Women with positive fetal fibronectin screening results and a short cervix had greater risks both of preterm birth caused by premature rupture of membranes at <37 weeks' gestation (relative risk, 4.9) and of preterm birth caused by premature rupture of membranes at <35 weeks' gestation (relative risk, 13.5) than did those without these risk factors. Multiparous women with all three risk factors had a 31. 3-fold increased risk of preterm birth caused by premature rupture of membranes at <35 weeks' gestation.
The combination of short cervical length, previous preterm birth caused by preterm premature rupture of membranes, and positive fetal fibronectin screening results was highly associated with preterm delivery caused by preterm premature rupture of membranes in the current gestation.
我们的目的是确定人口统计学特征、临床危险因素及辅助筛查试验在预测胎膜早破所致早产中的相对重要性。
在10个中心对2929名妊娠23至24周的妇女进行了评估。确定了人口统计学和临床特征。评估了宫颈阴道胎儿纤连蛋白和细菌性阴道病。通过阴道超声测量宫颈长度。对妊娠<37周和<35周时因胎膜早破导致的自发性早产患者进行了评估。分别对未产妇和经产妇进行了多因素分析。
妊娠<37周时胎膜早破使4.5%的妊娠复杂化，占早产的32.6%。单因素分析显示，低体重指数、肺部疾病、2周内宫缩、宫颈短（≤25mm）、胎儿纤连蛋白筛查阳性、细菌性阴道病以及既往因胎膜早破导致的早产（经产妇）与本次妊娠因胎膜早破导致的早产显著相关。宫颈短、经产妇既往因胎膜早破导致的早产以及胎儿纤连蛋白的存在是妊娠<37周和<35周时因胎膜早破导致早产的最强预测因素。胎儿纤连蛋白筛查结果阳性且宫颈短的妇女，妊娠<37周时因胎膜早破导致早产（相对危险度，4.9）和妊娠<35周时因胎膜早破导致早产（相对危险度，13.5）的风险均高于无这些危险因素的妇女。具有所有这三种危险因素的经产妇，妊娠<35周时因胎膜早破导致早产的风险增加31.3倍。
宫颈长度短、既往因早产胎膜早破导致的早产以及胎儿纤连蛋白筛查结果阳性这三者的组合与本次妊娠因早产胎膜早破导致的早产高度相关。
