van de Mheen Lidewij, Schuit Ewoud, Lim Arianne C, Porath Martina M, Papatsonis Dimitri, Erwich Jan J, van Eyck Jim, van Oirschot Charlotte M, Hummel Piet, Duvekot Johannes J, Hasaart Tom H M, Groenwold Rolf H H, Moons Karl G M, de Groot Christianne J M, Bruinse Hein W, van Pampus Maria G, Mol Ben W J
VU University Medical Center, the Netherlands.
Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands; Academic Medical Center, Amsterdam, the Netherlands.
J Obstet Gynaecol Can. 2014 Apr;36(4):309-319. doi: 10.1016/S1701-2163(15)30606-X.
To develop a multivariable prognostic model for the risk of preterm delivery in women with multiple pregnancy that includes cervical length measurement at 16 to 21 weeks' gestation and other variables.
We used data from a previous randomized trial. We assessed the association between maternal and pregnancy characteristics including cervical length measurement at 16 to 21 weeks' gestation and time to delivery using multivariable Cox regression modelling. Performance of the final model was assessed for the outcomes of preterm and very preterm delivery using calibration and discrimination measures.
We studied 507 women, of whom 270 (53%) delivered < 37 weeks (preterm) and 66 (13%) < 32 weeks (very preterm). Women with cervical length < 30 mm delivered more often preterm (hazard ratio 1.9; 95% CI 0.7 to 4.8). Other independently contributing predictors were previous preterm delivery, monochorionicity, smoking, educational level, and triplet pregnancy. Prediction models for preterm and very preterm delivery had a c-index of 0.68 (95% CI 0.63 to 0.72) and 0.68 (95% CI 0.62 to 0.75), respectively, and showed good calibration.
In women with a multiple pregnancy, the risk of preterm delivery can be assessed with a multivariable model incorporating cervical length and other predictors.
建立一个多变量预后模型，用于评估多胎妊娠妇女的早产风险，该模型纳入妊娠16至21周时的宫颈长度测量值及其他变量。
我们使用了一项既往随机试验的数据。我们采用多变量Cox回归模型评估包括妊娠16至21周时的宫颈长度测量值在内的母体和妊娠特征与分娩时间之间的关联。使用校准和区分度测量方法评估最终模型对早产和极早产结局的表现。
我们研究了507名妇女，其中270名（53%）在<37周时分娩（早产），66名（13%）在<32周时分娩（极早产）。宫颈长度<30mm的妇女早产的情况更常见（风险比1.9；95%置信区间0.7至4.8）。其他独立的预测因素包括既往早产、单绒毛膜性、吸烟、教育水平和三胎妊娠。早产和极早产的预测模型的c指数分别为0.68（95%置信区间0.63至0.72）和0.68（95%置信区间0.62至0.75），并显示出良好的校准。
在多胎妊娠妇女中，可以使用一个纳入宫颈长度和其他预测因素的多变量模型来评估早产风险。
