Fait Gideon, Har-Toov Joseph, Gull Ilan, Lessing Joseph B, Jaffa Ariel, Wolman Igal
Department of Obstetrics and Gynecology, U.S. Unit in Ob & Gyn, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman St., Tel Aviv 64239, Israel.
J Clin Ultrasound. 2005 Sep;33(7):329-32. doi: 10.1002/jcu.20159.
To evaluate the application of transvaginal sonography assessment of cervical length before fetal reduction for predicting spontaneous preterm birth in triplet gestations reduced to twins.
This retrospective study was conducted at the ultrasound unit of a university-affiliated municipal hospital. The study cohort consisted of 25 women with triplet gestations following ovulation induction or assisted-reproduction techniques who underwent fetal reduction to twins. Cervical length was assessed via transvaginal sonography before fetal reduction, and data on pregnancy outcome were retrieved from maternal records and/or maternal interviews.
Cervical length (mean +/- SD) at reduction was 4.0 +/- 0.85 (range: 1.2-5.5). Five women were excluded from statistical evaluation because pregnancy complications precluded spontaneous delivery. Two of 3 (67%) women with a cervical length of <3.5 cm delivered prior to 33 weeks' gestation compared with 1/17 (6%) women with a cervical length > or = 3.5 cm. This difference was statistically significant (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of cervical lengths <3.5 cm to predict delivery prior to 33 gestational weeks was 67%, 94%, 67%, and 94%, respectively.
Measurement of cervical length in triplet pregnancies before fetal reduction provides useful predictive information on the risk for preterm delivery.
评估在减胎前经阴道超声测量宫颈长度对预测三胎妊娠减为双胎后自发性早产的应用价值。
本回顾性研究在一所大学附属市级医院的超声科进行。研究队列包括25例因诱导排卵或辅助生殖技术而怀有三胎妊娠且接受减胎为双胎的妇女。在减胎前通过经阴道超声评估宫颈长度，并从产妇记录和/或产妇访谈中获取妊娠结局数据。
减胎时宫颈长度（均值±标准差）为4.0±0.85（范围：1.2 - 5.5）。5名妇女因妊娠并发症排除了自然分娩而被排除在统计评估之外。3例宫颈长度<3.5 cm的妇女中有2例（67%）在妊娠33周前分娩，而宫颈长度≥3.5 cm的17例妇女中有1例（6%）在妊娠33周前分娩。这种差异具有统计学意义（P<0.05）。宫颈长度<3.5 cm预测妊娠33周前分娩的敏感性、特异性、阳性预测值和阴性预测值分别为67%、94%、67%和94%。
在三胎妊娠减胎前测量宫颈长度可为早产风险提供有用的预测信息。
