宫颈长度因不同人群和妊娠结局而异：系统评价和荟萃分析的结果。
Cervical length varies considering different populations and gestational outcomes: Results from a systematic review and meta-analysis.
机构信息
School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
University of Pernambuco (UPE), Recife, Pernambuco, Brazil.
出版信息
PLoS One. 2021 Feb 16;16(2):e0245746. doi: 10.1371/journal.pone.0245746. eCollection 2021.
BACKGROUND
The uterine cervical length is an important risk factor for preterm birth. The aim of this study was to assess cervical length distribution in women with singleton pregnancies, measured by transvaginal ultrasound between 16 and 24 weeks, and its association with population characteristics.
MATERIALS AND METHODS
We searched electronic databases and other sources for studies published from April 1, 1990 to July 21, 2020. Of the 2019 retrieved publications, full-text versions of 137 articles were considered. We included 77 original articles that reported cervical length measurements of 363,431 women. The main aim of this study was to identify the pattern of cervical length in different populations. We collected demographic and clinical data concerning the population, in addition to information regarding the ultrasound examination and cervical length measurement. Regarding study bias, 56 were at low risk of bias and 21 were at medium risk of bias.
RESULTS
The meta-analysis included 57 articles with data from 158,346 women. The mean cervical length was 37.96. mm (95% CI [36.68, 39.24]). Cervical length was shorter in women from Africa and Asia, in those from low-income countries, with a lower body weight, and in those who delivered before 37 gestational weeks. We found that the cervical length from pooled studies is longer than that usually discussed in the literature. Regarding limitations, we had difficulty assessing our main variable because there was no consistent pattern in the way authors reported cervical length measurement. Another limitation was the great heterogeneity between studies.
CONCLUSIONS
The use of a single cutoff value to define a short cervix diagnosis, an important risk factor for preterm birth, may not be correct and cervical length must be considered according to maternal population characteristics. Future studies should identify different specific curves and cutoff values for cervical length in different populations. This meta-analysis was registered in the PROSPERO database under CRD42017070246 at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=70246.
背景
子宫颈长度是早产的一个重要危险因素。本研究旨在评估经阴道超声在 16 至 24 周之间测量的单胎妊娠女性的宫颈长度分布及其与人群特征的关系。
材料与方法
我们检索了电子数据库和其他来源，以获取 1990 年 4 月 1 日至 2020 年 7 月 21 日发表的研究。在检索到的 2019 篇文献中，有 137 篇的全文被认为是符合条件的。我们纳入了 77 篇原始文章，这些文章报告了 363431 名女性的宫颈长度测量结果。本研究的主要目的是确定不同人群中宫颈长度的模式。我们收集了与人群有关的人口统计学和临床数据，以及与超声检查和宫颈长度测量有关的信息。关于研究偏倚，56 项研究为低偏倚风险，21 项研究为中偏倚风险。
结果
荟萃分析包括 57 项研究，涉及 158346 名女性。宫颈长度的平均值为 37.96mm（95%CI [36.68, 39.24]）。来自非洲和亚洲的女性、来自低收入国家的女性、体重较低的女性以及在 37 孕周前分娩的女性的宫颈长度较短。我们发现，来自汇总研究的宫颈长度比文献中通常讨论的要长。关于局限性，我们很难评估我们的主要变量，因为作者报告宫颈长度测量的方式没有一致的模式。另一个局限性是研究之间存在很大的异质性。
结论
使用单一的截断值来定义短宫颈（早产的一个重要危险因素）的诊断可能是不正确的，宫颈长度必须根据产妇人群的特点来考虑。未来的研究应该确定不同人群中宫颈长度的不同特定曲线和截断值。本荟萃分析已在 PROSPERO 数据库中注册，注册号为 CRD42017070246，网址为 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=70246。
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