Division of Maternal Fetal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Obstetrics Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.
Am J Perinatol. 2020 Nov;37(13):1289-1295. doi: 10.1055/s-0040-1710008. Epub 2020 Apr 28.
This study aimed to identify the incidence of and risk factors for early preterm birth (PTB) (delivery <34 weeks) in women without prior PTB and current short cervix (≤20 mm) prescribed vaginal progesterone.
Retrospective cohort study of singletons without prior PTB diagnosed with short cervix (≤20 mm) between 18 and 23 weeks. Women who accepted vaginal progesterone and had delivery outcomes available were included. Demographic/obstetric history, cervical length, and pregnancy characteristics compared between women with early PTB versus delivery ≥34 weeks. Multiple logistic regression analysis used to identify predictors; odds ratio for significant factors used to generate a risk score. Risk score and risk of early PTB assessed with receiver operating characteristic curve (ROCC). Perinatal outcomes compared by risk score.
Among 109 patients included, 29 (27%) had a spontaneous PTB <34 weeks. In univariate analysis, only gestational age at ultrasound, presence funneling, and mean cervical length were significantly different between those with and without early sPTB. With multiple logistic regression analysis, only gestational age at diagnosis (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.46-0.96; = 0.028) and index cervical length (OR: 0.84; 95% CI: 0.76-0.93; = 0.001) remained significantly associated with early PTB. ROCC for the risk score incorporating cervical length and gestational age was predictive of early PTB with an AUC of 0.76 (95% CI: 0.67-0.86; < 0.001). A high-risk score was predictive of early PTB with a sensitivity of 79%, specificity of 75%, positive predictive value of 54%, and negative predictive value of 91%. Women with a high-risk score had worse perinatal outcomes compared with those with low-risk score.
A total of 27% of patients with short cervix prescribed vaginal progesterone will have a sPTB < 34 weeks. Patients at high risk for early PTB despite vaginal progesterone therapy may be identified using gestational age and cervical length at diagnosis of short cervix. Given the narrow window for intervention after diagnosis of short cervix, this has important implications for clinical care.
本研究旨在确定无早产史且当前存在短宫颈（≤20mm）的女性中，接受阴道孕酮治疗后发生早产（<34 周）的发生率及相关风险因素。
回顾性队列研究纳入了在 18 至 23 周诊断为短宫颈（≤20mm）且无早产史的单胎孕妇。纳入接受阴道孕酮治疗且分娩结局可获得的孕妇。比较了早产组（<34 周）与分娩≥34 周组的孕妇的人口统计学/产科病史、宫颈长度和妊娠特征。采用多因素逻辑回归分析确定预测因素，使用显著因素的比值比生成风险评分。采用受试者工作特征曲线（ROC）评估风险评分和早产风险。通过风险评分比较围产期结局。
在 109 名纳入的患者中，29 名（27%）发生自发性早产<34 周。单因素分析显示，仅超声检查时的孕周、宫颈漏斗形成和平均宫颈长度在早产组与非早产组之间存在显著差异。多因素逻辑回归分析显示，仅诊断时的孕周（比值比[OR]：0.66；95%置信区间[CI]：0.46-0.96； = 0.028）和指数宫颈长度（OR：0.84；95%CI：0.76-0.93； = 0.001）与早产显著相关。纳入宫颈长度和孕周的风险评分的 ROC 曲线对早产有预测作用，AUC 为 0.76（95%CI：0.67-0.86； < 0.001）。高风险评分预测早产的敏感度为 79%，特异度为 75%，阳性预测值为 54%，阴性预测值为 91%。与低风险评分相比，高风险评分的孕妇围产期结局更差。
尽管接受了阴道孕酮治疗，但仍有 27%的短宫颈孕妇会发生早产（<34 周）。通过诊断时的孕周和宫颈长度，可以识别出短宫颈患者尽管接受了阴道孕酮治疗但仍有发生早产的高风险。鉴于短宫颈诊断后的干预时间窗口较窄，这对临床护理具有重要意义。
