Department of Ultrasonic Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Ultrasound Med. 2020 Apr;39(4):705-713. doi: 10.1002/jum.15149. Epub 2019 Oct 18.
The aim of this study was to determine whether cervical elastographic parameters in addition to cervical length (CL) during the 3 trimesters of pregnancy would be predictive of spontaneous preterm birth (sPTB) among low-risk women.
This work was a prospective nested case-control study evaluating cervical elastographic parameters and CL in low-risk women during the 3 trimesters of pregnancy. A binary logistic regression analysis was used to calculate significant covariates for prediction of sPTB. The area under the curve of the prediction model was calculated by using a receiver operating characteristic curve.
There were 286 women (26 cases and 260 controls) included in the analysis. The parameters of cervical elasticity became softened and heterogeneous during the 3 trimesters of pregnancy in both women with and without sPTB. The differences in the mean strain value at the internal os of the cervix (IOS), ratio (strain ratio of the internal os to the external os) during the second trimester and the IOS during the third trimester between the groups had statistical significance (P < .01; P = .01; P < .01, respectively). The CL had no association with sPTB during the 3 trimesters. The IOS during the second trimester was a better predictor of sPTB, with an area under the curve of 0.730, and sensitivity was 72.73%.
We observed multiple elastographic parameters and demonstrated the physiologic changes in the cervix during the 3 trimesters of pregnancy. Furthermore, we found that the IOS during the second trimester can be helpful in predicting sPTB. However, the CL had no association with sPTB during the 3 trimesters of pregnancy.
本研究旨在确定在妊娠的前 3 个孕期中，除了宫颈长度（CL）以外，宫颈弹性的参数是否可预测低危孕妇自发性早产（sPTB）。
这是一项前瞻性的巢式病例对照研究，评估了低危孕妇在妊娠的前 3 个孕期中宫颈弹性参数和 CL。使用二元逻辑回归分析计算用于预测 sPTB 的显著协变量。使用受试者工作特征曲线计算预测模型的曲线下面积。
共有 286 名妇女（26 例和 260 例对照）纳入分析。在有和没有 sPTB 的妇女中，宫颈弹性的参数在妊娠的前 3 个孕期中变得柔软和不均匀。在第 2 孕期宫颈内口（IOS）的平均应变值、内口与外口的比值（IOS 应变比）和第 3 孕期 IOS 的差异具有统计学意义（P <.01；P =.01；P <.01，分别）。CL 在妊娠的前 3 个孕期与 sPTB 无关。第 2 孕期的 IOS 是 sPTB 的更好预测指标，曲线下面积为 0.730，灵敏度为 72.73%。
我们观察到多个弹性参数，并展示了在妊娠的前 3 个孕期中宫颈的生理变化。此外，我们发现第 2 孕期的 IOS 有助于预测 sPTB。然而，CL 在妊娠的前 3 个孕期与 sPTB 无关。
