To M S, Skentou C A, Royston P, Yu C K H, Nicolaides K H
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK.
Ultrasound Obstet Gynecol. 2006 Apr;27(4):362-7. doi: 10.1002/uog.2773.
To develop a model for calculating the patient-specific risk of spontaneous early preterm delivery by combining maternal factors and the transvaginal sonographic measurement of cervical length at 22 + 0 to 24 + 6 weeks, and to compare the detection rate of this method to that achieved from screening by cervical length or maternal characteristics alone.
This was a population-based prospective multicenter study involving 40,995 unselected women with singleton pregnancies attending for routine hospital antenatal care in London, UK. Complete follow-up was obtained from 39,284 (95.8%) cases. The main outcomes were detection rate, false-positive rate and accuracy of predicting spontaneous delivery before 32 weeks' gestation.
Spontaneous delivery before 32 weeks occurred in 235 (0.6%) cases. The detection rate of screening for early preterm delivery, at a fixed false-positive rate of 10%, was 38% for maternal factors, 55% for cervical length and 69% for combined testing. There was good agreement between the model estimates and the observed probabilities of preterm delivery.
This study provides a model that can give an accurate patient-specific risk of preterm delivery. The detection rate of screening by a combination of maternal factors and the measurement of cervical length was substantially higher than that of screening by each method alone.
通过整合母体因素以及在孕22 + 0至24 + 6周时经阴道超声测量宫颈长度，开发一种用于计算特定患者自发性早期早产风险的模型，并将该方法的检测率与单独通过宫颈长度或母体特征进行筛查的检测率进行比较。
这是一项基于人群的前瞻性多中心研究，涉及英国伦敦40,995名单胎妊娠且未经过筛选的孕妇，她们因常规医院产前检查前来就诊。从39,284例（95.8%）病例中获得了完整的随访数据。主要结局指标为检测率、假阳性率以及预测妊娠32周前自发性分娩的准确性。
235例（0.6%）发生了妊娠32周前的自发性分娩。在固定假阳性率为10%的情况下，早期早产筛查的检测率对于母体因素为38%，对于宫颈长度为55%，对于联合检测为69%。模型估计值与观察到的早产概率之间具有良好的一致性。
本研究提供了一种能够准确给出特定患者早产风险的模型。通过母体因素与宫颈长度测量相结合进行筛查的检测率显著高于单独采用每种方法进行筛查的检测率。
