Odibo Anthony O, Farrell Catherine, Macones George A, Berghella Vincenzo
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
J Perinatol. 2003 Dec;23(8):664-7. doi: 10.1038/sj.jp.7211004.
To develop a model for identifying women receiving cervical cerclage at risk for spontaneous preterm birth <32 weeks.
Retrospective cohort study of high-risk patients based on past obstetric history. Our inclusion criteria involved all patients with singleton gestation who received cerclage between 10 and 24 weeks. They were evaluated for the risk factors associated with preterm birth <32 weeks. Risk factors evaluated include: indication for cerclage, gestational age at cerclage placement, cervical length prior to cerclage, timing of cerclage (emergency or elective) and route of cerclage (abdominal or vaginal). Univariable and multivariable analyses were used to determine the risk factors associated with preterm birth. A risk-scoring model was developed for the prediction of preterm birth <32 weeks in women receiving cerclage.
We identified 256 women receiving cerclage that met our inclusion criteria. Preterm births <32 weeks occurred in 51 (20%). Multivariable analysis revealed a cervical length <25 mm, a history of cone biopsy and emergency cerclage to be significant risk factors associated with preterm birth <32 weeks. The sensitivity, specificity, positive and negative predictive values of the best model for predicting spontaneous preterm birth <32 weeks in women with cerclage are 80%; 96%; 82% and 95%, respectively.
The presence of a short cervical length, a history of cone biopsy and emergency cerclage were associated with preterm birth <32 weeks. Our model had a high sensitivity for identifying women who may benefit from a closer surveillance.
建立一个模型，用于识别接受宫颈环扎术且有自发早产<32周风险的女性。
基于既往产科病史对高危患者进行回顾性队列研究。我们的纳入标准包括所有单胎妊娠且在10至24周之间接受环扎术的患者。对她们进行<32周早产相关危险因素的评估。评估的危险因素包括：环扎术的指征、环扎时的孕周、环扎术前的宫颈长度、环扎时机（急诊或择期）以及环扎途径（经腹或经阴道）。采用单变量和多变量分析来确定与早产相关的危险因素。开发了一个风险评分模型，用于预测接受环扎术的女性<32周早产情况。
我们确定了256名符合纳入标准的接受环扎术的女性。<32周早产的有51例（20%）。多变量分析显示，宫颈长度<25mm、宫颈锥切活检史和急诊环扎术是与<32周早产相关的显著危险因素。预测接受环扎术女性<32周自发早产的最佳模型的敏感性、特异性、阳性预测值和阴性预测值分别为80%、96%、82%和95%。
宫颈长度短、宫颈锥切活检史和急诊环扎术与<32周早产有关。我们的模型在识别可能从密切监测中获益的女性方面具有较高的敏感性。
