Reis F M, Gervasi M T, Florio P, Bracalente G, Fadalti M, Severi F M, Petraglia F
Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy.
Am J Obstet Gynecol. 2003 Nov;189(5):1361-7. doi: 10.1067/s0002-9378(03)00725-7.
The purpose of this study was to evaluate whether biochemical (fetal fibronectin assay) or biophysical (cervical assessment by transvaginal ultrasound) tests may have more value than digital examination in predicting successful induction of labor at term.
The study enrolled prospectively 134 women undergoing labor induction at term caused by several obstetric conditions. All participants submitted to digital examination, fetal fibronectin assay, and transvaginal ultrasound for measurement of the cervical length and detection of funneling. The performance of each test in predicting delivery within 24 hours of labor induction was evaluated. Cox multiple regression analysis was performed to identify, among clinical and laboratory tests, which variables were independently associated with the duration of the latent phase and with the total duration of induced labor.
The likelihood ratios for positive results (predicting that delivery would occur within 24 hours) were 6.61 (95% CI, 1.7-25.8) for a positive obstetric history (previous vaginal delivery), 2.61 (95% CI, 1.6-4.3) for a "favorable" digital examination, 1.41 (95% CI, 0.9-2.2) for a positive fetal fibronectin test, 1.61 (95% CI, 0.9-3.0) for cervical length, and 2.20 (95% CI, 1.1-4.4) for the presence of funneling at transvaginal ultrasound. The likelihood ratios for negative results were 1.81 (1.3-2.5) for obstetric history, 4.34 (2.5-7.7) for digital examination, 1.41 (0.9-2.1) for fetal fibronectin, 1.29 (1.0-1.7) for cervical length, and 1.48 (1.1-2.0) for funneling. On multiple regression, the only variables independently associated with the duration of the latent phase and with the total duration of induced labor were obstetric history and digital examination.
Only obstetric history and digital examination predicted accurately vaginal delivery within 24 hours and were independently associated with labor duration. Fetal fibronectin and ultrasound measurements failed to predict accurately the outcome of induced labor.
本研究旨在评估生化检查（胎儿纤连蛋白检测）或生物物理检查（经阴道超声评估宫颈情况）在预测足月引产成功方面是否比指诊更有价值。
该研究前瞻性纳入了134名因多种产科情况而接受足月引产的女性。所有参与者均接受了指诊、胎儿纤连蛋白检测以及经阴道超声检查，以测量宫颈长度并检测宫颈漏斗形成情况。评估了每项检查在预测引产24小时内分娩方面的性能。进行了Cox多因素回归分析，以确定在临床和实验室检查中，哪些变量与潜伏期时长以及引产总时长独立相关。
阳性结果（预测在24小时内分娩）的似然比分别为：有阳性产科史（既往经阴道分娩）为6.61（95%可信区间，1.7 - 25.8），指诊“良好”为2.61（95%可信区间，1.6 - 4.3），胎儿纤连蛋白检测阳性为1.41（95%可信区间，0.9 - 2.2），宫颈长度为1.61（95%可信区间，0.9 - 3.0），经阴道超声检查存在宫颈漏斗形成为2.20（95%可信区间，1.1 - 4.4）。阴性结果的似然比分别为：产科史为1.81（1.3 - 2.5），指诊为4.34（2.5 - 7.7），胎儿纤连蛋白为1.41（0.9 - 2.1），宫颈长度为1.29（1.0 - 1.7），宫颈漏斗形成为1.48（1.1 - 2.）。多因素回归分析显示与潜伏期时长以及引产总时长独立相关的唯一变量是产科史和指诊。
只有产科史和指诊能够准确预测24小时内的阴道分娩情况，并且与产程独立相关。胎儿纤连蛋白检测和超声测量未能准确预测引产结局。
