对34周前有先兆早产且7天内未分娩的女性，采用宫颈长度和胎儿纤维连接蛋白进行风险分层。
Risk stratification with cervical length and fetal fibronectin in women with threatened preterm labor before 34 weeks and not delivering within 7 days.
作者信息
Hermans Frederik J R, Bruijn Merel M C, Vis Jolande Y, Wilms Femke F, Oudijk Martijn A, Porath Martina M, Scheepers Hubertina C J, Bloemenkamp Kitty W M, Bax Caroline J, Cornette Jérôme M J, Nij Bijvanck Bas W A, Franssen Maureen T M, Vandenbussche Frank P H A, Kok Marjolein, Grobman William A, Van Der Post Joris A M, Bossuyt Patrick M M, Opmeer Brent C, Mol Ben Willem J, Schuit Ewoud, Van Baaren Gert-Jan
机构信息
Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands.
Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands.
出版信息
Acta Obstet Gynecol Scand. 2015 Jul;94(7):715-721. doi: 10.1111/aogs.12643. Epub 2015 Apr 29.
OBJECTIVE
To stratify the risk of spontaneous preterm delivery using cervical length (CL) and fetal fibronectin (fFN) in women with threatened preterm labor who remained pregnant after 7 days.
DESIGN
Prospective observational study.
SETTING
Nationwide cohort of women with threatened preterm labor from the Netherlands.
POPULATION
Women with threatened preterm labor between 24 and 34 weeks with a valid CL and fFN measurement and remaining pregnant 7 days after admission.
METHODS
Kaplan-Meier and Cox proportional hazards models were used to estimate cumulative percentages and hazard ratios (HR) for spontaneous delivery.
MAIN OUTCOME MEASURES
Spontaneous delivery between 7 and 14 days after initial presentation and spontaneous preterm delivery before 34 weeks.
RESULTS
The risk of delivery between 7 and 14 days was significantly increased for women with a CL < 15 mm or a CL ≥15 to <30 mm and a positive fFN, compared with women with a CL ≥30 mm: HR 22.3 [95% confidence interval (CI) 2.6-191] and 14 (95% CI 1.8-118), respectively. For spontaneous preterm delivery before 34 weeks the risk was increased for women with a CL < 15 mm [HR 6.3 (95% CI 2.6-15)] or with a CL ≥15 to <30 mm with either positive fFN [HR 3.6 (95% CI 1.5-8.7)] or negative fFN [HR 3.0 (95% CI 1.2-7.1)] compared with women with a CL ≥ 30 mm.
CONCLUSIONS
In women remaining pregnant 7 days after threatened preterm labor, CL and fFN results can be used in risk stratification for spontaneous delivery.
目的
在有早产风险且7天后仍未分娩的孕妇中，利用宫颈长度（CL）和胎儿纤连蛋白（fFN）对自然早产风险进行分层。
设计
前瞻性观察性研究。
地点
荷兰全国范围内有早产风险的孕妇队列。
研究对象
孕周在24至34周之间、有早产风险且CL和fFN测量结果有效、入院7天后仍未分娩的孕妇。
方法
采用Kaplan-Meier法和Cox比例风险模型估计自然分娩的累积百分比和风险比（HR）。
主要观察指标
初次就诊后7至14天内的自然分娩以及34周前的自然早产。
结果
与CL≥30mm的孕妇相比，CL<15mm或CL≥15至<30mm且fFN阳性的孕妇在7至14天内分娩的风险显著增加，HR分别为22.3[95%置信区间（CI）2.6 - 191]和14（95%CI 1.8 - 118）。对于34周前的自然早产，与CL≥30mm的孕妇相比，CL<15mm的孕妇[HR 6.3（95%CI 2.6 - 15）]或CL≥15至<30mm且fFN阳性[HR 3.6（95%CI 1.5 - 8.7）]或fFN阴性[HR 3.0（95%CI 1.2 - 7.1）]的孕妇早产风险增加。
结论
在有早产风险且7天后仍未分娩的孕妇中，CL和fFN结果可用于自然分娩的风险分层。
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