低 Bishop 评分女性中，宫颈数字检查与超声检查在预测引产至分娩时间间隔方面的比较。

Comparison of digital and ultrasonographic examination of the cervix in predicting time interval from induction to delivery in women with a low Bishop score.

作者信息

Rozenberg Patrick, Chevret Sylvie, Chastang Claude, Ville Yves

机构信息

Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Versailles-St Quentin University, France.

出版信息

BJOG. 2005 Feb;112(2):192-6. doi: 10.1111/j.1471-0528.2004.00549.x.

DOI:10.1111/j.1471-0528.2004.00549.x

PMID:15663583

Abstract

OBJECTIVE

To compare pre-induction ultrasonographic cervical length and Bishop score in predicting time to delivery after labour induction with prostaglandins.

DESIGN

Prognostic cohort study.

SETTING

Tertiary referral maternity unit in a teaching hospital.

POPULATION

Two hundred and sixty-six women with singleton pregnancies at between 34(+0) and 41(+3) weeks of gestation requiring induction of labour with prostaglandins for medical indications.

METHODS

A secondary analysis of a trial comparing two prostaglandins. Assessment of the Bishop score and measurement of the cervical length by transvaginal sonography were performed by two operators, blinded to each other's results. We estimated the predictive effects on the outcomes of ultrasonographic cervical length and Bishop score.

MAIN OUTCOME MEASURE

Time intervals from induction to delivery and to vaginal delivery.

RESULTS

Cervical length and Bishop score were associated with the time interval from induction to delivery, based on univariable analyses. When considered jointly in a multivariable model, only the Bishop score was significantly related to the outcome: The higher the Bishop score, the higher the hazard to delivery [hazard ratio (HR): 1.2, 95% confidence interval (CI): 1.1-1.3], illustrating that once the Bishop score is taken into account, further knowledge of cervical ultrasound length (HR: 0.99, 95% CI: 0.98-1.0) did not add any predictive information. Also, Bishop score was predictive of time interval between induction and vaginal delivery (HR: 1.2, 95% CI: 1.1-1.4) while cervical length had no additional predictive value (HR: 0.99, 95% CI: 0.98-1.0) when both cervical length and Bishop score were introduced in the model.

CONCLUSIONS

The Bishop score appears to be a better predictor of the time interval from induction to delivery and to vaginal delivery than cervical length after induction of labour for medical reasons.

摘要

目的

比较引产术前超声测量的宫颈长度和Bishop评分在预测使用前列腺素引产至分娩时间方面的作用。

设计

预后队列研究。

地点

一家教学医院的三级转诊产科病房。

研究对象

266名单胎妊娠女性，孕周在34(+0)至41(+3)周之间，因医学指征需要使用前列腺素引产。

方法

对一项比较两种前列腺素的试验进行二次分析。由两名操作人员在彼此结果不知情的情况下评估Bishop评分并经阴道超声测量宫颈长度。我们评估了超声测量的宫颈长度和Bishop评分对结局的预测作用。

主要结局指标

引产至分娩以及至阴道分娩的时间间隔。

结果

单变量分析显示，宫颈长度和Bishop评分与引产至分娩的时间间隔相关。在多变量模型中综合考虑时，只有Bishop评分与结局显著相关：Bishop评分越高，分娩风险越高[风险比(HR)：1.2，95%置信区间(CI)：1.1 - 1.3]，这表明一旦考虑了Bishop评分，进一步了解宫颈超声长度(HR：0.99，95%CI：0.98 - 1.0)并不能增加任何预测信息。此外，当模型中同时纳入宫颈长度和Bishop评分时，Bishop评分可预测引产至阴道分娩的时间间隔(HR：1.2，95%CI：1.1 - 1.4)，而宫颈长度无额外预测价值(HR：0.99，95%CI：0.98 - 1.0)。