Maymon Ron, Melcer Yaakov, Tovbin Josef, Pekar-Zlotin Marina, Smorgick Noam, Jauniaux Eric
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, England.
J Ultrasound Med. 2018 Mar;37(3):717-723. doi: 10.1002/jum.14411. Epub 2017 Sep 7.
There is no consensus about the optimal surveillance strategy in women with a diagnosis of vasa previa. The aim of this study was to evaluate the role of the rate of change in cervical length measurements in the management of singleton pregnancies with a diagnosis of vasa previa.
We performed a retrospective case-control study of our databases for pregnancies with a prenatal diagnosis of vasa previa that were followed with transvaginal sonography for cervical length and evaluated the impact of the changes in cervical length on the need for emergency cesarean delivery.
The cohort included 29 singleton pregnancies with a prenatal diagnosis of vasa previa in the second trimester. There were 14 and 15 pregnancies that underwent elective and emergency cesarean delivery, respectively. The rate of cervical length shortening was significantly slower for women with elective compared to emergency cesarean delivery (median [range], 0.7 [0.1-2.0] versus 1.5 [0.25-3.0] mm/wk; P = .011). For each additional millimeter-per-week decrease in cervical length, the odds of emergency cesarean delivery increased by 6.50 (95% confidence interval, 1.02-41.20). The receiver operating characteristic curve for the rate of cervical length shortening in the prediction of emergency cesarean delivery yielded an area under the curve of 0.85 (95% confidence interval, 0.69-0.99).
Our findings indicate an association between the rate of cervical length shortening and the risk of emergency cesarean delivery in pregnancies with a diagnosis of vasa previa in the second trimester. Further multicentric studies are required to validate our data prospectively and, in particular, the role of serial cervical length measurements in determining the optimal delivery time for individual cases.
对于诊断为前置血管的女性，最佳监测策略尚无共识。本研究的目的是评估宫颈长度测量变化率在诊断为前置血管的单胎妊娠管理中的作用。
我们对数据库中产前诊断为前置血管且经阴道超声监测宫颈长度的妊娠进行了一项回顾性病例对照研究，并评估宫颈长度变化对急诊剖宫产需求的影响。
该队列包括29例孕中期产前诊断为前置血管的单胎妊娠。分别有14例和15例妊娠接受了择期和急诊剖宫产。与急诊剖宫产的女性相比，择期剖宫产女性的宫颈长度缩短率明显较慢（中位数[范围]，0.7[0.1 - 2.0]对1.5[0.25 - 3.0]mm/周；P = 0.011）。宫颈长度每周每额外减少1毫米，急诊剖宫产的几率增加6.50（95%置信区间，1.02 - 41.20）。宫颈长度缩短率预测急诊剖宫产的受试者工作特征曲线下面积为0.85（95%置信区间，0.69 - 0.99）。
我们的研究结果表明，孕中期诊断为前置血管的妊娠中，宫颈长度缩短率与急诊剖宫产风险之间存在关联。需要进一步的多中心研究来前瞻性地验证我们的数据，特别是连续宫颈长度测量在确定个体病例最佳分娩时间中的作用。
