Rosati P, Ciliberti P, Buongiorno S, Alessio A, Mappa I, Guariglia L, Capelli G, Scambia G
Dipartimento per la Tutela della Salute della Donna e della Vita Nascente Università Cattolica del Sacro Cuore, Roma, Italia -
Minerva Ginecol. 2014 Apr;66(2):193-9.
The aim of this study was to evaluate the role of Bishop score, sonographic measurements of uterine cervical length and maternal characteristics, as predictors of spontaneous onset of labor within 24 hours, as well as response to induction in prolonged pregnancies.
Pregnancies with gestational age over 280 days were followed as outpatient. Patients were included in the study if spontaneous delivery occurred between 286 and 295 days of gestation, or in pregnancies with gestational age of 291-293 days who required labor induction. Data about Bishop score, ultrasonographic cervical characteristics (length, funneling, volume) and maternal features (parity, body mass index and age) registered at the last control immediately before the delivery were retrieved from clinical charts.
Data from 195 patients were available. Bishop score and, in particular, ultrasonographic cervical length can predict the spontaneous onset of labor with a positive predictive value (PPV) of 22% and 44%, respectively in 24 hours. On the other hands, in patients requiring labor induction, parity and ultrasonographic cervical length remained the only predictive parameters with a PPV of 39% and 42%, respectively. In term of predictive performance, the value of 30 mm was identified as the best cut-off value for the ultrasonographic cervical length (specificity 59% and sensitivity 69%).
In prolonged pregnancies, Bishop score and ultrasonographic cervical length were shown to be relevant in the prediction of spontaneous onset of labor, while in patients who required labor induction, ultrasonographic cervical length represented the only clinic parameter predicting the onset of labor.
本研究旨在评估Bishop评分、超声测量的宫颈长度及母体特征作为妊娠24小时内自然临产预测指标的作用，以及过期妊娠引产的反应。
对孕周超过280天的孕妇进行门诊随访。若孕妇在妊娠286至295天之间自然分娩，或在妊娠291 - 293天需要引产，则纳入本研究。从临床病历中获取分娩前最后一次检查时记录的Bishop评分、超声宫颈特征（长度、漏斗形成、容积）及母体特征（产次、体重指数和年龄）的数据。
可获得195例患者的数据。Bishop评分，尤其是超声测量的宫颈长度可预测自然临产，24小时内的阳性预测值（PPV）分别为22%和44%。另一方面，在需要引产的患者中，产次和超声测量的宫颈长度仍然是仅有的预测参数，PPV分别为39%和42%。就预测性能而言，超声测量的宫颈长度30 mm被确定为最佳截断值（特异性59%，敏感性69%）。
在过期妊娠中，Bishop评分和超声测量的宫颈长度在预测自然临产方面具有相关性，而在需要引产的患者中，超声测量的宫颈长度是预测临产的唯一临床参数。
