中孕期宫颈长度测量预测无症状三胎妊娠自发性早产。
Cervical-length measurement in mid-gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancy.
机构信息
Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy.
Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy.
出版信息
Ultrasound Obstet Gynecol. 2018 May;51(5):614-620. doi: 10.1002/uog.17464. Epub 2018 Apr 10.
OBJECTIVE
To assess the predictive value of sonographic cervical-length (CL) measurement in mid-gestation for spontaneous preterm birth (PTB) in asymptomatic triplet pregnancy.
METHODS
This was a retrospective study of asymptomatic triplet pregnancies followed at five Italian tertiary referral centers, between 2002 and 2015. CL was measured transvaginally between 18 and 24 weeks' gestation. Pregnancies with medically indicated PTB were excluded. Demographic and pregnancy characteristics of pregnancies complicated by PTB were analyzed and the distributions of CL measurements in these patients were calculated. Logistic regression analysis was performed to assess the association between CL and PTB, adjusted for confounders. Performance of CL measurement in prediction of PTB < 28, < 30 and < 32 weeks of gestation was assessed.
RESULTS
A total of 120 triplet pregnancies were included in the final analysis. Median CL was 35 (interquartile range (IQR), 29-40) mm measured at a median gestational age of 20 + 2 (IQR, 20 + 0 to 23 + 4) weeks. Overall, 23 (19.2%), 17 (14.2%) and eight (6.7%) patients had a CL < 25, < 20 and < 15 mm, respectively. Spontaneous PTB < 32 weeks occurred in 41 (34.2%) cases, < 30 weeks in 23 (19.2%) and < 28 weeks in 12 (10%) cases. CL < 15 mm was significantly more frequent in the group of patients who delivered < 28 (P = 0.03) and < 30 (P = 0.01) weeks' gestation, compared with those who delivered after 28 and after 30 weeks, respectively, while CL < 20 mm was more common in triplet pregnancies with delivery < 32 weeks compared with those delivered ≥ 32 weeks (P = 0.03). Logistic regression analysis was possible only for PTB < 32 weeks due to the small number of cases that delivered < 30 and < 28 weeks. After adjustment for confounders, CL was not significantly associated with PTB < 32 weeks (adjusted odds ratio, 0.97; 95% CI, 0.94-1.01). CL measurement had an area under the receiver-operating characteristics curve of 0.41 (95% CI, 0.20-0.62), 0.41 (95% CI, 0.26-0.56) and 0.42 (95% CI, 0.31-0.54) for the prediction of spontaneous PTB < 28, < 30 and < 32 weeks, respectively.
CONCLUSION
CL assessed in mid-gestation is a poor predictor of PTB < 28, < 30 and < 32 weeks' gestation in asymptomatic triplet pregnancy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
目的
评估中孕期经阴道超声测量宫颈长度（CL）对无症状三胎妊娠自发性早产（PTB）的预测价值。
方法
这是一项回顾性研究，纳入了 2002 年至 2015 年在意大利五家三级转诊中心就诊的无症状三胎妊娠。在 18 至 24 孕周时经阴道测量 CL。排除因医学指征需要早产的妊娠。分析 PTB 并发症妊娠的人口统计学和妊娠特征，并计算这些患者的 CL 测量值分布。采用 logistic 回归分析评估 CL 与 PTB 之间的关联，调整混杂因素。评估 CL 测量值对预测 <28 周、<30 周和 <32 周 PTB 的性能。
结果
共纳入 120 例三胎妊娠进行最终分析。中位 CL 为 35（四分位距（IQR），29-40）mm，在中位孕龄 20+2（IQR，20+0 至 23+4）周时测量。总体而言，分别有 23（19.2%）、17（14.2%）和 8（6.7%）例患者的 CL<25、<20 和 <15 mm。41 例（34.2%）发生自发性 <32 周 PTB，23 例（19.2%）和 12 例（10%）发生 <30 周和 <28 周 PTB。与分别在 28 周和 30 周后分娩的患者相比，CL<15 mm 在分娩 <28 周（P=0.03）和 <30 周（P=0.01）的患者中更常见，而 CL<20 mm 在分娩 <32 周的三胎妊娠中更常见与分娩≥32 周的患者相比（P=0.03）。由于分娩 <30 周和 <28 周的病例较少，仅对 PTB<32 周进行了 logistic 回归分析。调整混杂因素后，CL 与 PTB<32 周无显著相关性（调整后的优势比，0.97；95%CI，0.94-1.01）。CL 测量值对预测自发性 <28 周、<30 周和 <32 周 PTB 的受试者工作特征曲线下面积分别为 0.41（95%CI，0.20-0.62）、0.41（95%CI，0.26-0.56）和 0.42（95%CI，0.31-0.54）。
结论
在无症状三胎妊娠中，中孕期经阴道超声测量 CL 是预测 <28 周、<30 周和 <32 周 PTB 的一项较差指标。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
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