Carbonne Bruno
Department of Obstetrics and Gynaecology, Service de Gynécologie Obstétrique, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75012 Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2004 Nov 15;117 Suppl 1:S6-9. doi: 10.1016/j.ejogrb.2004.07.008.
Preterm labour is a frequent cause of admission to hospital during pregnancy. However, in most cases, preterm labour is diagnosed with reference to clinical criteria only. Since the clinical assessment of uterine contractions and of cervical changes is highly subjective, few of the patients admitted to the hospital with suspected preterm labour will ultimately deliver preterm. There is a need for sensitive methods of detecting patients who are genuinely at high risk of preterm birth, but on the other hand, specific methods of reducing unnecessary treatments or hospital admissions are also required. Recently, a few techniques such as ultrasonographic measurement of cervical length and fetal fibronectin have been introduced into clinical practice with the aim of improving prediction of the risk of actual preterm delivery. In the future, the assessment of cervical status may be based not only on anatomical changes, but also on functional criteria. New techniques are being developed for evaluation of the mechanical properties of the cervix (cervical distensibility), noninvasive measurement of its collagen content (light-induced fluorescence of cervical collagen), or even direct assessment of the changes in cervical water content (magnetic resonance imaging). Correlations have been found between these measurements and the risk of preterm birth, but clinical studies are still needed to allow better assessment of the predictive value of these new methods in clinical practice.
早产是孕期住院的常见原因。然而，在大多数情况下，早产仅根据临床标准进行诊断。由于子宫收缩和宫颈变化的临床评估具有高度主观性，很少有因疑似早产入院的患者最终会早产。需要有灵敏的方法来检测真正有早产高风险的患者，但另一方面，也需要有减少不必要治疗或住院的具体方法。最近，诸如超声测量宫颈长度和检测胎儿纤连蛋白等一些技术已被引入临床实践，目的是改善对实际早产风险的预测。未来，宫颈状况的评估可能不仅基于解剖学变化，还基于功能标准。正在开发新技术来评估宫颈的力学特性（宫颈扩张性）、无创测量其胶原蛋白含量（宫颈胶原蛋白的光诱导荧光），甚至直接评估宫颈含水量的变化（磁共振成像）。已发现这些测量值与早产风险之间存在相关性，但仍需要进行临床研究，以便更好地评估这些新方法在临床实践中的预测价值。
