Poggi S H, Ghidini A, Landy H J, Alvarez M, Pezzullo J C, Collea J V
Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, District of Columbia 20007, USA.
J Matern Fetal Neonatal Med. 2002 Jul;12(1):46-9. doi: 10.1080/jmf.12.1.46.49.
To establish whether cervical length is a predictor of spontaneous preterm delivery at < or = 32 weeks in triplet pregnancies.
This was a case-control study of all triplet pregnancies followed with more than three sonographic assessments of cervical length at 4-week intervals from 1995 to 2000. Cervical length in women delivered spontaneously at < or = 32 weeks (cases) was compared with that of the remaining women (controls). Statistical analysis included Fisher's exact test, chi2 test, one-way analysis of variance, logistic regression and receiver operating characteristic (ROC) curve to determine optimal cervical length thresholds for spontaneous preterm delivery at < or = 32 weeks.
Of the 58 women included in the study, 17 (29%) delivered spontaneously at < or = 32 weeks. The preterm delivery group had similar demographic and obstetric variables, but a higher rate of cerclage placement (65% vs 17%, p < 0.001) than controls. Mean +/- standard deviation cervical length was significantly shorter among cases than controls at 16-20.0 weeks (3.0 +/- 1.2 vs. 3.9 +/- 0.8 cm, p = 0.01), but not at 20.1-24.0 weeks (3.5 +/- 1.1 vs. 3.8 +/- 1.0 cm, p = 0.76). Logistic regression analysis determined that cervical length at 16-20 weeks had an odds ratio of 0.43 (95% CI = 0.23, 0.80) for the prediction of spontaneous preterm delivery at < or = 32 weeks. ROC curve analysis identified a cervical length of < or = 2.6 cm as the optimal threshold for the prediction of spontaneous preterm delivery at < or = 32 weeks (sensitivity 41%, specificity 92%).
In a population of triplet gestations with a 29% rate of preterm delivery, cervical length at 16-20.0 weeks, but not at 20.1-24.0 weeks, was inversely correlated with the probability of preterm delivery at < or = 32 weeks.
确定宫颈长度是否可作为三胎妊娠在32周及以内自然早产的预测指标。
这是一项病例对照研究，纳入了1995年至2000年期间所有接受至少三次超声检查、每隔4周测量一次宫颈长度的三胎妊娠病例。将32周及以内自然分娩的女性（病例组）的宫颈长度与其余女性（对照组）的宫颈长度进行比较。统计分析包括Fisher精确检验、卡方检验、单因素方差分析、逻辑回归以及受试者工作特征（ROC）曲线分析，以确定预测32周及以内自然早产的最佳宫颈长度阈值。
该研究纳入的58名女性中，17名（29%）在32周及以内自然分娩。早产组在人口统计学和产科变量方面与对照组相似，但宫颈环扎术的实施率高于对照组（65%对17%，p<0.001）。在16至20.0周时，病例组的平均±标准差宫颈长度显著短于对照组（3.0±1.2对3.9±0.8厘米，p = 0.01），但在20.1至24.0周时差异无统计学意义（3.5±1.1对3.8±1.0厘米，p = 0.76）。逻辑回归分析确定，16至20周时的宫颈长度预测32周及以内自然早产的比值比为0.43（95%CI = 0.23，0.80）。ROC曲线分析确定，宫颈长度≤2.6厘米是预测32周及以内自然早产的最佳阈值（敏感性41%，特异性92%）。
在早产率为29%的三胎妊娠人群中，16至20.0周时的宫颈长度与32周及以内早产的可能性呈负相关，而20.1至24.0周时则无此相关性。
