Drassinower Daphnie, Običan Sarah G, Siddiq Zainab, Heller Danielle, Gyamfi-Bannerman Cynthia, Friedman Alexander M
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.
Am J Obstet Gynecol. 2015 Nov;213(5):686.e1-7. doi: 10.1016/j.ajog.2015.07.029. Epub 2015 Jul 26.
The objective of the study was to determine whether risk of recurrent preterm birth differs based on the clinical presentation of a prior spontaneous preterm birth (SPTB): advanced cervical dilatation (ACD), preterm premature rupture of membranes (PPROM), or preterm labor (PTL).
This retrospective cohort study included singleton pregnancies from 2009 to 2014 complicated by a history of prior SPTB. Women were categorized based on the clinical presentation of their prior preterm delivery as having ACD, PPROM, or PTL. Risks for sonographic short cervical length and recurrent SPTB were compared between women based on the clinical presentation of their prior preterm birth. Log-linear regression was used to control for confounders.
Of 522 patients included in this study, 96 (18.4%) had prior ACD, 246 (47.1%) had prior PPROM, and 180 (34.5%) had prior PTL. Recurrent PTB occurred in 55.2% of patients with a history of ACD compared with 27.2% of those with PPROM and 32.2% with PTL (P = .001). The mean gestational age at delivery was significantly lower for those with a history of ACD (34.0 weeks) compared with women with prior PPROM (37.2 weeks) or PTL (37.0 weeks) (P = .001). The lowest mean cervical length prior to 24 weeks was significantly shorter in patients with a history of advanced cervical dilation when compared with the other clinical presentations.
Patients with a history of ACD are at an increased risk of having recurrent preterm birth and cervical shortening in a subsequent pregnancy compared with women with prior preterm birth associated PPROM or PTL.
本研究的目的是确定复发性早产风险是否因既往自发性早产（SPTB）的临床表现而异：宫颈扩张提前（ACD）、胎膜早破（PPROM）或早产临产（PTL）。
这项回顾性队列研究纳入了2009年至2014年期间因既往有SPTB病史而并发的单胎妊娠。根据既往早产的临床表现，将女性分为ACD、PPROM或PTL组。根据既往早产的临床表现，比较女性之间超声检查发现宫颈短的风险和复发性SPTB的风险。采用对数线性回归来控制混杂因素。
本研究纳入的522例患者中，96例（18.4%）既往有ACD，246例（47.1%）既往有PPROM，180例（34.5%）既往有PTL。有ACD病史的患者中复发性早产的发生率为55.2%，而有PPROM病史的患者为27.2%，有PTL病史的患者为32.2%（P = 0.001）。有ACD病史的患者分娩时的平均孕周（34.0周）显著低于既往有PPROM（37.2周）或PTL（37.0周）的女性（P = 0.001）。与其他临床表现相比，宫颈扩张提前病史的患者在24周前的最低平均宫颈长度明显更短。
与既往有PPROM或PTL相关早产的女性相比，有ACD病史的患者在随后的妊娠中复发性早产和宫颈缩短的风险增加。
