预测中孕期宫颈长度较短的孕妇无症状宫颈扩张：一项随机对照试验的二次分析。
Predicting asymptomatic cervical dilation in pregnant patients with short mid-trimester cervical length: A secondary analysis of a randomized controlled trial.
机构信息
Division of Maternal Fetal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Division of Maternal Fetal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Acta Obstet Gynecol Scand. 2019 Jun;98(6):761-768. doi: 10.1111/aogs.13545. Epub 2019 Feb 27.
INTRODUCTION
Second trimester asymptomatic cervical dilation is a significant risk factor for early preterm birth. The objective of this study is to evaluate whether transvaginal ultrasound cervical length (CL) predicts asymptomatic cervical dilation on physical exam in women with short cervix (CL ≤25 mm) and no prior preterm birth.
MATERIAL AND METHODS
Secondary analysis of a randomized trial on pessary in asymptomatic singletons without prior preterm birth diagnosed with CL ≤25 mm between 18 and 23 weeks. Participants had transvaginal ultrasound and physical cervical exam and were randomized to pessary or no pessary with all patients with cervical length ≤20 mm offered vaginal progesterone. The primary outcome was to determine whether CL was predictive of asymptomatic physical cervical dilation ≥1 cm using receiver operating characteristic curve.
RESULTS
In all, 119 women were included. Based on receiver operating characteristic curve, CL ≤11 mm was best predictive of cervical dilation ≥1 cm, with 75% sensitivity, 80% specificity, and area under the curve 0.73 (0.55-0.91), P = 0.009. Cervical length ≤11 mm had increased incidence of cervical dilation ≥1 cm on physical exam (30% vs 3%, odds ratio 12.29 (3.05-49.37) P < 0.001) with a negative predictive value of 97%. Patients with ≥1 cm dilation had increased preterm birth <37 weeks (75% vs 39%, P = 0.03) compared to those not dilated. Women with a CL ≤11 mm had increased preterm birth <37 weeks (77% vs 31%, P < 0.001), preterm birth <34 weeks (63% vs 22%, P < 0.001), and lower birthweight (1552 ± 1047 vs 2560 ± 1072 g, P < 0.001) compared to women with CL >11 mm.
CONCLUSIONS
Among singletons without prior preterm birth diagnosed with short cervix (≤25 mm), CL ≤11 mm may identify a subgroup of patients at high risk for asymptomatic cervical dilation and poor perinatal outcome. Physical exam should be considered and adjunctive preterm birth prevention measures should be studied in singletons with CL ≤11 mm.
简介
中期无症状宫颈扩张是早产的重要危险因素。本研究的目的是评估经阴道超声宫颈长度（CL）是否可预测无早产史的短宫颈（CL≤25mm）无症状妇女的宫颈扩张。
材料和方法
对无早产史的无症状单胎妊娠妇女的随机试验进行二次分析，这些妇女在 18 至 23 周时诊断为 CL≤25mm。所有 CL≤20mm 的患者均接受阴道孕酮治疗，并进行经阴道超声和物理宫颈检查，并随机分为使用子宫托或不使用子宫托。主要结局是使用接受者操作特征曲线确定 CL 是否可预测无症状的物理宫颈扩张≥1cm。
结果
共纳入 119 名妇女。根据接受者操作特征曲线，CL≤11mm 对宫颈扩张≥1cm 的预测最佳，敏感性为 75%，特异性为 80%，曲线下面积为 0.73（0.55-0.91），P=0.009。CL≤11mm 的患者进行物理检查时，宫颈扩张≥1cm 的发生率增加（30%比 3%，优势比 12.29（3.05-49.37），P<0.001），阴性预测值为 97%。与未扩张的患者相比，扩张≥1cm 的患者早产<37 周（75%比 39%，P=0.03）的发生率增加。CL≤11mm 的妇女早产<37 周（77%比 31%，P<0.001）、早产<34 周（63%比 22%，P<0.001）和低出生体重（1552±1047 比 2560±1072g，P<0.001）的发生率增加。
结论
在无早产史的短宫颈（≤25mm）的单胎妊娠妇女中，CL≤11mm 可能可以识别无症状宫颈扩张和围产期结局不良的高危亚组患者。对于 CL≤11mm 的单胎妊娠妇女，应考虑进行体格检查，并研究辅助早产预防措施。
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