经阴道超声测量中孕期宫颈长度预测早产：一项盲法前瞻性多中心诊断准确性研究。
Second-trimester transvaginal ultrasound measurement of cervical length for prediction of preterm birth: a blinded prospective multicentre diagnostic accuracy study.
机构信息
Department of Obstetrics and Gynaecology, Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Södra Älvsborg Hospital, Borås, Sweden.
出版信息
BJOG. 2021 Jan;128(2):195-206. doi: 10.1111/1471-0528.16519. Epub 2020 Oct 19.
OBJECTIVE
To estimate the diagnostic performance of sonographic cervical length for the prediction of preterm birth (PTB).
DESIGN
Prospective observational multicentre study.
SETTING
Seven Swedish ultrasound centres.
SAMPLE
A cohort of 11 456 asymptomatic women with a singleton pregnancy.
METHODS
Cervical length was measured with transvaginal ultrasound at 18-20 weeks of gestation (C×1) and at 21-23 weeks of gestation (C×2, optional). Staff and participants were blinded to results.
MAIN OUTCOME MEASURES
Area under receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR-), number of false-positive results per true-positive result (FP/TP), number needed to screen to detect one PTB (NNS) and prevalence of 'short' cervix.
RESULTS
Spontaneous PTB (sPTB) at <33 weeks of gestation occurred in 56/11 072 (0.5%) women in the C×1 population (89% white) and in 26/6288 (0.4%) in the C×2 population (92% white). The discriminative ability of shortest endocervical length was better the earlier the sPTB occurred and was better at C×2 than at C×1 (AUC to predict sPTB at <33 weeks of gestation 0.76 versus 0.65, difference in AUC 0.11, 95% CI 0.01-0.23). At C×2, the shortest endocervical length of ≤25 mm (prevalence 4.4%) predicted sPTB at <33 weeks of gestation with sensitivity 38.5% (10/26), specificity 95.8% (5998/6262), PPV 3.6% (10/274), NPV 99.7% (5988/6014), LR+ 9.1, LR- 0.64, FP/TP 26 and NNS 629.
CONCLUSIONS
Second-trimester sonographic cervical length can identify women at high risk of sPTB. In a population of mainly white women with a low prevalence of sPTB its diagnostic performance is at best moderate.
TWEETABLE ABSTRACT
Cervical length screening to predict preterm birth in a white low-risk population has moderate performance.
目的
评估超声宫颈长度预测早产（PTB）的诊断性能。
设计
前瞻性观察性多中心研究。
地点
瑞典 7 家超声中心。
样本
11456 例无症状单胎妊娠孕妇。
方法
经阴道超声于 18-20 周（C×1）和 21-23 周（C×2，可选）测量宫颈长度。工作人员和参与者对结果均不知情。
主要观察指标
受试者工作特征曲线下面积（AUC）、敏感度、特异度、阳性和阴性预测值（PPV 和 NPV）、阳性和阴性似然比（LR+ 和 LR-）、每例真阳性结果的假阳性结果数（FP/TP）、每检出 1 例 PTB 所需的筛查例数（NNS）和“短”宫颈的发生率。
结果
C×1 人群中，89%为白人，<33 孕周自发性早产（sPTB）发生率为 56/11072（0.5%）；C×2 人群中，92%为白人，<33 孕周 sPTB 发生率为 26/6288（0.4%）。sPTB 发生越早，最短宫颈内口长度的鉴别能力越好，C×2 优于 C×1（预测<33 孕周 sPTB 的 AUC 为 0.76 比 0.65，AUC 差异为 0.11，95%CI 为 0.01-0.23）。在 C×2 中，最短宫颈内口长度≤25mm（发生率为 4.4%）预测<33 孕周 sPTB 的敏感度为 38.5%（10/26），特异度为 95.8%（5998/6262），PPV 为 3.6%（10/274），NPV 为 99.7%（5988/6014），LR+为 9.1，LR-为 0.64，FP/TP 为 26，NNS 为 629。
结论
中孕期超声宫颈长度可识别 sPTB 高危孕妇。在白人低危人群中，其诊断性能最多为中等。
推特摘要
在白人低危人群中，筛查宫颈长度预测早产的表现为中等。
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