使用宫颈长度预测出现早产症状的孕妇的分娩开始时间。
Prediction of labour onset in women who present with symptoms of preterm labour using cervical length.
机构信息
Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore.
Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
出版信息
BMC Pregnancy Childbirth. 2021 May 5;21(1):359. doi: 10.1186/s12884-021-03828-z.
BACKGROUND
Diagnosis of preterm labour is difficult because initial symptoms and signs are often mild and may occur in continuing pregnancies. This study aims to investigate the utility of measuring cervical length, using transvaginal ultrasound, in women presenting to the delivery suite with symptoms of preterm labour.
METHODS
This was a prospective cohort study performed in KK Women's and Children's Hospital, Singapore from September 2017 to July 2018. Women with singleton pregnancies, presenting with symptoms of contraction pain, between 24 to 36 weeks gestation, were included. Transvaginal ultrasound cervical length measurements were done at presentation to the labour ward, after four hours and in the following morning. The primary outcome of the study was delivery within 1 week. All statistical analyses were conducted with Microsoft Excel and Statistical Package for the Social Sciences.
RESULTS
A total of 95 subjects were included. A one-millimeter increase in the 1st cervical length increases scan-to-delivery time by 0.802 days (p-value 0.003, CI 0.280-1.323). Receiver Operator Characteristic (ROC) curve analysis for prediction of delivery within 1 week showed an Area Under Curve (AUC) of 0.667, optimal cut-off value of 27.5mm (sensitivity 77.8 %, specificity 61.6 %). A one-millimetre increase in the 3rd cervical length increases scan-to-delivery time by 0.770 days (p-value 0.023, CI 0.108-1.432). ROC curve analysis for prediction of delivery within 1 week showed an AUC of 0.915, optimal cut-off value of 25.5mm (sensitivity 100 %, specificity 73.6 %). However, the change in cervical length over a period of 1 day was not significant in predicting delivery within 1 week.
CONCLUSIONS
Our results indicate that by using a cervical length cut off of 27.5mm at presentation, we would have predicted 77.8 % of deliveries within 1 week. If we were to repeat the cervical length scan the next day, with the same cut-off of 27.5mm, we would have predicted 100 % of deliveries within 1 week. In our study, measuring the transvaginal ultrasound cervical length is a reliable diagnostic test for delivery within 1 week. However, the results are limited by the small sample size. Further studies should be conducted with a larger sample size.
背景
早产的诊断较为困难，因为最初的症状和体征通常较轻，并且可能发生在持续妊娠中。本研究旨在探讨经阴道超声测量宫颈长度在有早产症状的产妇中用于诊断的作用。
方法
这是一项于 2017 年 9 月至 2018 年 7 月在新加坡 KK 妇女儿童医院进行的前瞻性队列研究。纳入单胎妊娠、有宫缩痛症状且在 24 至 36 周之间的产妇。在进入产房后 4 小时和次日早晨，对产妇进行经阴道超声宫颈长度测量。本研究的主要结局为 1 周内分娩。所有统计分析均使用 Microsoft Excel 和社会科学统计软件包进行。
结果
共纳入 95 例患者。第 1 宫颈长度增加 1 毫米，扫描至分娩时间增加 0.802 天（p 值<0.003，CI 0.280-1.323）。预测 1 周内分娩的受试者工作特征（ROC）曲线分析显示，曲线下面积（AUC）为 0.667，最佳截断值为 27.5mm（敏感度 77.8%，特异度 61.6%）。第 3 宫颈长度增加 1 毫米，扫描至分娩时间增加 0.770 天（p 值=0.023，CI 0.108-1.432）。预测 1 周内分娩的 ROC 曲线分析显示，AUC 为 0.915，最佳截断值为 25.5mm（敏感度 100%，特异度 73.6%）。然而，1 天内宫颈长度的变化在预测 1 周内分娩方面无显著意义。
结论
我们的结果表明，通过使用 27.5mm 的宫颈长度截断值，我们可以预测 77.8%的患者在 1 周内分娩。如果我们在第 2 天重复经阴道超声宫颈长度检查，使用相同的 27.5mm 截断值，我们可以预测 100%的患者在 1 周内分娩。在本研究中，经阴道超声测量宫颈长度是一种可靠的 1 周内分娩的诊断性检查。然而，结果受到样本量较小的限制。应进一步进行更大样本量的研究。
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