Parry Samuel, Elovitz Michal A
Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Clin Obstet Gynecol. 2014 Sep;57(3):537-46. doi: 10.1097/GRF.0000000000000051.
Large randomized controlled trials have demonstrated that universal maternal cervical length screening and treatment with daily vaginal progesterone in women with short cervical length reduces the risk of preterm birth, but large numbers of women must be screened to prevent a relatively small number of preterm deliveries. Issues that should be considered while implementing universal cervical length screening include: (1) the standards of quality and reproducibility for transvaginal ultrasound cervical length ascertainment; and (2) the implications of screening on the application of therapeutic strategies to populations not known to benefit (so-called "indication creep"). Optimal strategies to employ cervical ultrasound and progesterone treatment might be revealed by additional studies investigating cervical length cutoffs, frequency of screening, selective screening in higher-risk groups, and the use of transabdominal cervical length screening as a surrogate for transvaginal cervical length screening.
大型随机对照试验表明，对所有孕妇进行宫颈长度筛查，并对宫颈长度短的女性每日使用阴道孕酮进行治疗，可降低早产风险，但必须对大量女性进行筛查，才能预防相对少数的早产分娩。实施普遍宫颈长度筛查时应考虑的问题包括：（1）经阴道超声测量宫颈长度的质量和可重复性标准；（2）筛查对将治疗策略应用于未知是否受益人群（即所谓的“指征蔓延”）的影响。通过进一步研究宫颈长度临界值、筛查频率、高危人群的选择性筛查以及使用经腹宫颈长度筛查替代经阴道宫颈长度筛查，可能会揭示采用宫颈超声和孕酮治疗的最佳策略。
