足月未产妇引产前行超声宫颈长度测量。

Sonographic cervical length measurement before labor induction in term nulliparous women.

作者信息

Daskalakis George, Thomakos Nikolaos, Hatziioannou Leonardos, Mesogitis Spyros, Papantoniou Nikolaos, Antsaklis Aris

机构信息

1st Department of Obstetrics and Gynaecology, University of Athens, Athens, Greece.

出版信息

Fetal Diagn Ther. 2006;21(1):34-8. doi: 10.1159/000089045.

DOI:10.1159/000089045

PMID:16354972

Abstract

OBJECTIVE

The purpose of the study was to determine if transvaginal sonographic measurement of the cervical length is a useful method to predict successful labor induction in nulliparas.

METHODS

137 women who were scheduled for medically indicated induction of labor had a transvaginal sonographic measurement of the cervical length before labor induction. Inclusion criteria were: (1) singleton pregnancy; (2) gestational age between 37-42 weeks; (3) live fetus in cephalic presentation; (4) intact membranes; (5) no vaginal bleeding; (6) no previous history of uterine surgery; (7) nulliparous women, and (8) no allergy or asthma in response to prostaglandins. Induction of labor was performed within 6 h of the ultrasonographic examination, by inserting 2 mg of dinoprostone in the posterior vaginal fornix, repeated if needed every 6 h for up to three doses. When the cervix became favorable and no regular contractions were observed, amniotomy and oxytocin augmentation, starting at 1 mIU/min and increasing 1 mIU every 30 min as necessary, was performed.

RESULTS

All women were Caucasians and the mean age was 24.3 years (range 19-37 years). The mean cervical length was 28 mm (range 11-39 mm). The Bishop score was < or =5 in 101 women and >5 in the 36 others. Vaginal delivery occurred in 92 women (67.1%), and the vast majority of them (89 women; 96.7%) gave birth within 24 h of induction. Forty-five women (32.8%) had a cesarean section. The Bishop score was not predictive of the mode of delivery. Thirty-six of 101 women (35.6%) with a Bishop score < or =5 delivered by cesarean section, compared to 9 of 36 women with a Bishop score >5 (25%) (p = NS). Women with a cervical length <27 mm were more likely to deliver vaginally. Using this cutoff value the sensitivity of a successful labor induction was 76% and the specificity was 75.5%.

CONCLUSIONS

Transvaginal sonographic measurement of cervical length is a good predictor of a successful labor induction at term in nulliparas.

摘要

目的

本研究旨在确定经阴道超声测量宫颈长度是否是预测初产妇引产成功的有效方法。

方法

137名计划进行医学引产的女性在引产前行经阴道超声测量宫颈长度。纳入标准为：（1）单胎妊娠；（2）孕周在37 - 42周之间；（3）活胎头先露；（4）胎膜完整；（5）无阴道出血；（6）既往无子宫手术史；（7）初产妇；（8）对前列腺素无过敏或哮喘反应。在超声检查后6小时内进行引产，将2毫克地诺前列酮置入阴道后穹窿，必要时每6小时重复一次，最多三次。当宫颈条件适宜且未观察到规律宫缩时，行人工破膜并使用缩宫素加强宫缩，起始剂量为1 mIU/min，必要时每30分钟增加1 mIU。

结果

所有女性均为白种人，平均年龄为24.3岁（范围19 - 37岁）。平均宫颈长度为28毫米（范围11 - 39毫米）。101名女性的 Bishop 评分≤5分，另外36名女性的 Bishop 评分＞5分。92名女性（67.1%）经阴道分娩，其中绝大多数（89名女性；96.7%）在引产24小时内分娩。45名女性（32.8%）行剖宫产。Bishop 评分不能预测分娩方式。101名 Bishop 评分≤5分的女性中有36名（35.6%）行剖宫产，相比之下，36名 Bishop 评分＞5分的女性中有9名（25%）行剖宫产（p = 无显著性差异）。宫颈长度＜27毫米的女性更有可能经阴道分娩。采用此临界值，引产成功的敏感性为76%，特异性为75.5%。