Blanc J, Bretelle F
Service de gynécologie-obstétrique, gynépôle, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France.
Service de gynécologie-obstétrique, gynépôle, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Unité de recherche sur les maladies infectieuses tropicales et émergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille cedex 5, France.
J Gynecol Obstet Biol Reprod (Paris). 2016 Dec;45(10):1261-1279. doi: 10.1016/j.jgyn.2016.09.009. Epub 2016 Oct 29.
Describe tools designed to predict preterm birth in asymptomatic high-risk pregnancy and determine their predictive value.
The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.
Obstetric history particularly spontaneous preterm birth identifies a population at risk for preterm birth for the current pregnancy (LE3). This risk is related to the number of prior preterm birth and is even higher than the term of the prior event is more premature and that the event concerns the last pregnancy (LE3). The literature data are insufficient to recommend systematic cervical examination at each prenatal visit in asymptomatic high-risk pregnancy (multiple pregnancy, uterine malformations, history of spontaneous preterm birth, excisional cervical procedure or at least two voluntary first trimester abortion) (professional consensus). Regular recording of uterine activity and home visits for asymptomatic high-risk pregnancy did not predict nor reduce the risk of preterm birth (LE2) and are not recommended (grade B). In asymptomatic high-risk pregnancy, ultrasonographic measurement of cervical length estimates the risk of preterm birth (LE2). Shorter is the cervical length higher is the risk of preterm birth (LE3). In asymptomatic patient with prior preterm birth, ultrasonographic measurement of cervical length estimates the risk of preterm birth (LE2). The strategy of ultrasound indicated cerclage are discussed in dedicated chapter. The measurement of cervical length by transvaginal ultrasonography in asymptomatic pregnancy with uterine malformation, a history of cervical treatment, at least two voluntary abortions or having a multiple pregnancy would estimate the risk of preterm birth (LE3). A shortening of more than 10% of the cervical length at 3-week interval is associated with an increased risk of preterm birth (LE3). Systematic detection of fetal fibronectin is not recommended in asymptomatic high-risk population (grade C). The combination of ultrasound measurement of cervical length and fetal fibronectin detection improves modestly the prediction of preterm birth (LE3). However, literature data are insufficient to recommend routine measurement of cervical length by transvaginal ultrasonography during surveillance ultrasounds and/or detection of fetal fibronectin because this policy has never demonstrated its interest in preventing preterm birth and in the reduction of neonatal morbidity and mortality (professional consensus).
Several predictive tools are described to define the risk of preterm birth but there is no evidence to date of the effectiveness of systematic screening strategy on the prevention of prematurity in asymptomatic high-risk population, except the ultrasound measurement of the cervical length in the population of patients having had a prior preterm birth.
描述用于预测无症状高危妊娠早产的工具，并确定其预测价值。
查阅了PubMed数据库、Cochrane图书馆以及法国和国外产科协会或学院的相关建议。
产科病史，尤其是自发性早产，可识别当前妊娠有早产风险的人群（证据等级3）。这种风险与既往早产的次数有关，且如果既往早产的孕周更早以及该事件涉及最后一次妊娠，则风险更高（证据等级3）。文献数据不足以推荐在无症状高危妊娠（多胎妊娠、子宫畸形、自发性早产史、宫颈切除手术或至少两次孕早期人工流产）的每次产前检查时进行系统性宫颈检查（专业共识）。对无症状高危妊娠定期记录子宫活动情况和进行家访并不能预测或降低早产风险（证据等级2），因此不推荐（B级）。在无症状高危妊娠中，超声测量宫颈长度可评估早产风险（证据等级2）。宫颈长度越短，早产风险越高（证据等级3）。对于有既往早产史的无症状患者，超声测量宫颈长度可评估早产风险（证据等级2）。超声引导下宫颈环扎术的策略将在专门章节讨论。在有子宫畸形、宫颈治疗史、至少两次人工流产或多胎妊娠的无症状妊娠中，经阴道超声测量宫颈长度可评估早产风险（证据等级3）。宫颈长度在3周内缩短超过10%与早产风险增加相关（证据等级3）。不建议在无症状高危人群中进行系统性胎儿纤连蛋白检测（C级）。超声测量宫颈长度与检测胎儿纤连蛋白相结合可适度改善早产预测（证据等级3）。然而，文献数据不足以推荐在超声监测期间经阴道超声常规测量宫颈长度和/或检测胎儿纤连蛋白，因为该策略从未证明其在预防早产以及降低新生儿发病率和死亡率方面的益处（专业共识）。
描述了几种预测早产风险的工具，但迄今为止，除了对有既往早产史的患者进行超声测量宫颈长度外，尚无证据表明系统性筛查策略对预防无症状高危人群早产有效。
