早产预测研究：能否识别出注定会自然早产的低风险女性？

The preterm prediction study: can low-risk women destined for spontaneous preterm birth be identified?

作者信息

Iams J D, Goldenberg R L, Mercer B M, Moawad A H, Meis P J, Das A F, Caritis S N, Miodovnik M, Menard M K, Thurnau G R, Dombrowski M P, Roberts J H

机构信息

Department of Obstetrics and Gynecology, The Ohio State University Medical Center, Columbus, OH 43210, USA.

出版信息

Am J Obstet Gynecol. 2001 Mar;184(4):652-5. doi: 10.1067/mob.2001.111248.

DOI:10.1067/mob.2001.111248

PMID:11262467

Abstract

OBJECTIVE

Half of all preterm births occur in women without clinical risk factors. Our goal was to assess fetal fibronectin assay, Bishop score, and cervical ultrasonography as screening tests to predict which low-risk pregnancies will end in preterm birth.

STUDY DESIGN

We performed a secondary analysis of data collected at 22 to 24 weeks' gestation from low-risk subjects enrolled in the Preterm Prediction Study, an observational study of risk factors for preterm birth conducted by the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Analysis was limited to primigravid women and to women who did not have a history of preterm birth or spontaneous pregnancy loss at <20 weeks' gestation. Bishop score (> or =4), fetal fibronectin level (> or =50 ng/mL), and cervical length (< or =25 mm) at 24 weeks' gestation were evaluated alone and in sequence as tests to predict spontaneous delivery before 35 weeks' gestation.

RESULTS

Of the 2929 subjects enrolled in the original study, 2197 (1207 primigravid women and 900 low-risk multiparous women) met criteria for this analysis. There were 64 spontaneous births before 35 weeks' gestation (3.04%). All three tests were significantly related to birth before 35 weeks' gestation (high Bishop score: relative risk, 3.6; 95% confidence interval, 2.1-6.3; fetal fibronectin detection: relative risk, 8.2; 95% confidence interval, 4.8-13.9; short cervical length: relative risk, 6.9; 95% confidence interval, 4.3-11.1). However, the sensitivities of the tests alone were low (23.4% for high Bishop score, 23.4% for fetal fibronectin detection, and 39.1% for short cervix), as were the sensitivities for Bishop score followed by cervical ultrasonography (14.1%) and fetal fibronectin assay followed by cervical scan (15.6%).

CONCLUSION

In the setting of low-risk pregnancy, fetal fibronectin assay and cervical ultrasonography have low sensitivity for preterm birth before 35 weeks' gestation. Sequential screening with Bishop score or fetal fibronectin assay followed by cervical ultrasonography further decreased sensitivity to only 15% among low-risk women.

摘要

目的

所有早产中有一半发生在无临床风险因素的女性中。我们的目标是评估胎儿纤连蛋白检测、Bishop评分和宫颈超声检查作为筛查试验，以预测哪些低风险妊娠会以早产告终。

研究设计

我们对参加早产预测研究的低风险受试者在妊娠22至24周时收集的数据进行了二次分析，该研究是由美国国立儿童健康与人类发展研究所母胎医学单位网络进行的一项早产风险因素观察性研究。分析仅限于初产妇以及妊娠<20周时无早产或自然流产史的女性。单独并按顺序评估妊娠24周时的Bishop评分（≥4）、胎儿纤连蛋白水平（≥50 ng/mL）和宫颈长度（≤25 mm），作为预测妊娠35周前自然分娩的试验。

结果

在原研究纳入的2929名受试者中，2197名（1207名初产妇和900名低风险经产妇）符合本分析标准。妊娠35周前有64例自然分娩（3.04%）。所有三项试验均与妊娠35周前分娩显著相关（高Bishop评分：相对危险度，3.6；95%置信区间，2.1 - 6.3；胎儿纤连蛋白检测：相对危险度，8.2；95%置信区间，4.8 - 13.9；宫颈短：相对危险度，6.9；95%置信区间，4.3 - 11.1）。然而，单独试验的敏感度较低（高Bishop评分为23.4%，胎儿纤连蛋白检测为23.4%，宫颈短为39.1%），Bishop评分后进行宫颈超声检查的敏感度（14.1%）以及胎儿纤连蛋白检测后进行宫颈扫描的敏感度（15.6%）也较低。