Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA.
The George Washington University Biostatistics Center, Washington, DC, USA.
Ultrasound Obstet Gynecol. 2018 Dec;52(6):757-762. doi: 10.1002/uog.18960. Epub 2018 Oct 26.
To evaluate whether the presence of cervical funneling or intra-amniotic debris identified in the second trimester is associated with a higher rate of preterm birth (PTB) in asymptomatic nulliparous pregnant women with a midtrimester cervical length (CL) less than 30 mm (i.e. below the 10 percentile).
This was a secondary cohort analysis of data from a multicenter trial in nulliparous women between 16 and 22 weeks' gestation with a singleton gestation and CL less than 30 mm on transvaginal ultrasound, randomized to treatment with either 17-alpha-hydroxyprogesterone caproate or placebo. Sonographers were centrally certified in CL measurement, as well as in identification of intra-amniotic debris and cervical funneling. Univariable and multivariable analysis was performed to assess the associations of cervical funneling and intra-amniotic debris with PTB.
Of the 657 women randomized, 112 (17%) had cervical funneling only, 33 (5%) had intra-amniotic debris only and 45 (7%) had both on second-trimester ultrasound. Women with either of these findings had a shorter median CL than those without (21.0 mm vs 26.4 mm; P < 0.001). PTB prior to 37 weeks was more likely in women with cervical funneling (37% vs 21%; odds ratio (OR), 2.2 (95% CI, 1.5-3.3)) or intra-amniotic debris (35% vs 23%; OR, 1.7 (95% CI, 1.1-2.9)). Results were similar for PTB before 34 and before 32 weeks' gestation. After multivariable adjustment that included CL, PTB < 34 and < 32 weeks continued to be associated with the presence of intra-amniotic debris (adjusted OR (aOR), 1.85 (95% CI, 1.00-3.44) and aOR, 2.78 (95% CI, 1.42-5.45), respectively), but not cervical funneling (aOR, 1.17 (95% CI, 0.63-2.17) and aOR, 1.45 (95% CI, 0.71-2.96), respectively).
Among asymptomatic nulliparous women with midtrimester CL less than 30 mm, the presence of intra-amniotic debris, but not cervical funneling, is associated with an increased risk for PTB before 34 and 32 weeks' gestation, independently of CL. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
评估在中孕期宫颈长度（CL）小于 30 毫米（即低于第 10 百分位数）的无症状初产妇中，是否存在宫颈漏斗或羊水中有碎片与早产（PTB）的发生率增加有关。
这是一项多中心试验的二次队列分析，纳入了 16-22 周、单胎妊娠、经阴道超声检查 CL 小于 30 毫米的初产妇，随机分为 17-α-羟孕酮己酸酯或安慰剂治疗组。超声医师在 CL 测量以及羊水中有碎片和宫颈漏斗的识别方面接受了中心认证。采用单变量和多变量分析评估宫颈漏斗和羊水中有碎片与 PTB 的相关性。
在 657 名随机分配的妇女中，112 名（17%）仅有宫颈漏斗，33 名（5%）仅有羊水中有碎片，45 名（7%）在第二次超声检查中两者都有。与无这些发现的妇女相比，有这些发现的妇女的中位 CL 更短（21.0 毫米 vs 26.4 毫米；P<0.001）。有宫颈漏斗的妇女（37% vs 21%；比值比（OR），2.2（95%CI，1.5-3.3））或羊水中有碎片的妇女（35% vs 23%；OR，1.7（95%CI，1.1-2.9））发生 37 周前 PTB 的可能性更大。多变量调整包括 CL、34 周前和 32 周前 PTB 后，羊水中有碎片与 34 周前和 32 周前 PTB 仍相关（调整后比值比（aOR），1.85（95%CI，1.00-3.44）和 aOR，2.78（95%CI，1.42-5.45）），但宫颈漏斗与 34 周前和 32 周前 PTB 不相关（aOR，1.17（95%CI，0.63-2.17）和 aOR，1.45（95%CI，0.71-2.96））。
在中孕期 CL 小于 30 毫米的无症状初产妇中，宫颈漏斗的存在，而不是羊水中有碎片，与 34 周前和 32 周前 PTB 的风险增加有关，独立于 CL。
