宫颈长度测量和纤维连接蛋白检测在先兆早产中的预测价值。
Predictive value of cervical length measurement and fibronectin testing in threatened preterm labor.
机构信息
Departments of Obstetrics and Gynecology, Academic Medical Center and VU University Medical Center, Amsterdam, University Medical Center Utrecht, Utrecht, Maastricht University Medical Center, Maastricht, Máxima Medical Center, Veldhoven, Erasmus Medical Center, Rotterdam, Isala Clinics, Zwolle, University Medical Center Groningen, Groningen, Leiden University Medical Center, and Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands, Northwestern University Medical School, Chicago, Illinois, and The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia; Clinical Epidemiology, Biostatistics and Bioinformatics and the Clinical Research Unit, Academic Medical Center, Amsterdam, and the Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
Obstet Gynecol. 2014 Jun;123(6):1185-1192. doi: 10.1097/AOG.0000000000000229.
OBJECTIVE
To estimate the performance of combining cervical length measurement with fetal fibronectin testing in predicting delivery in women with symptoms of preterm labor.
METHODS
We conducted a prospective nationwide cohort study in all 10 perinatal centers in The Netherlands. Women with symptoms of preterm labor between 24 and 34 weeks of gestation with intact membranes were included. In all women, qualitative fibronectin testing (0.050-microgram/mL cutoff) and cervical length measurement were performed. Logistic regression was used to predict spontaneous preterm delivery within 7 days after testing. A risk less than 5%, corresponding to the risk for women with a cervical length of at least 25 mm, was considered as low risk.
RESULTS
Between December 2009 and August 2012, 714 women were enrolled. Fibronectin results and cervical length were available for 665 women, of whom 80 (12%) delivered within 7 days. Women with a cervical length of at least 30 mm or with a cervical length between 15 and 30 mm with a negative fibronectin result were at low risk (less than 5%) of spontaneous delivery within 7 days. Fibronectin testing in case of a cervical length between 15 and 30 mm additionally classified 103 women (15% of the cohort) as low risk and 36 women (5% of the cohort) as high risk.
CONCLUSION
Cervical length measurement, combined with fetal fibronectin testing in case of a cervical length between 15 and 30 mm, improves identification of women with a low risk to deliver spontaneously within 7 days.
LEVEL OF EVIDENCE
II.
目的
评估联合宫颈长度测量和胎儿纤维连接蛋白检测预测有早产症状的女性分娩的性能。
方法
我们在荷兰的 10 个围产中心进行了一项前瞻性全国性队列研究。纳入妊娠 24-34 周且胎膜完整的有早产症状的女性。所有女性均行定性纤维连接蛋白检测（0.050 微克/毫升截断值）和宫颈长度测量。采用逻辑回归预测检测后 7 天内自发性早产。风险小于 5%（相当于宫颈长度至少为 25 毫米的女性的风险）被认为是低风险。
结果
2009 年 12 月至 2012 年 8 月期间，共纳入 714 名女性。665 名女性纤维连接蛋白检测结果和宫颈长度可用，其中 80 名（12%）在 7 天内分娩。宫颈长度至少为 30 毫米或宫颈长度为 15-30 毫米且纤维连接蛋白检测结果为阴性的女性，7 天内自发性分娩的风险（<5%）较低。在宫颈长度为 15-30 毫米的情况下进行纤维连接蛋白检测，还将 103 名女性（队列的 15%）归类为低风险，36 名女性（队列的 5%）归类为高风险。
结论
宫颈长度测量联合宫颈长度为 15-30 毫米时的胎儿纤维连接蛋白检测，可提高在 7 天内自然分娩的低风险女性的识别率。
证据水平
II。
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