Research Center of CHU de Québec-Université Laval, Québec, Qc, Canada; Obstetrics Department, CHU Toulouse, Toulouse, France.
Research Center of CHU de Québec-Université Laval, Québec, Qc, Canada.
J Gynecol Obstet Hum Reprod. 2022 Feb;51(2):102287. doi: 10.1016/j.jogoh.2021.102287. Epub 2021 Dec 9.
To estimate the optimal midtrimester cervical length (CL) threshold for the prediction of spontaneous preterm birth (sPTB) in asymptomatic pregnant women.
This is a prospective observational cohort study including asymptomatic women with singleton pregnancies who underwent CL measurement by transabdominal and/or transvaginal ultrasound between 19° and 21 weeks of gestation. All CL ≤30 mm from transabdominal ultrasound were confirmed by transvaginal ultrasound. Primary outcomes were sPTB <35 and <37 weeks.
Out of 3,449 participants, 28 (0.8%) had a sPTB before 35 weeks and 99 (2.9%) had a sPTB before 37 weeks. Receiver operating characteristics (ROC) curves suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (sensitivity: 43%; specificity: 97%) and sPTB before 37 weeks (sensitivity: 21%; specificity: 97%). While a CL <25 mm was an important risk factor for sPTB before 35 weeks (relative risk: 31; 95% confidence interval: 13-73), women with a CL between 25 and 30 mm were also at greater risk (relative risk: 12; 95% confidence interval: 4 - 35) compared to women with CL ≥30 mm.
A midtrimester CL <30 mm should be considered to identify women at high-risk of sPTB.
评估孕中期宫颈长度（CL）预测无症状孕妇自发性早产（sPTB）的最佳截断值。
这是一项前瞻性观察性队列研究，纳入了 19 至 21 孕周经腹和/或经阴道超声检查的无症状单胎妊娠孕妇。所有经腹超声 CL ≤30mm 的孕妇均经经阴道超声确认。主要结局为 sPTB<35 周和 sPTB<37 周。
3449 名参与者中，28 名（0.8%）在 35 周前发生 sPTB，99 名（2.9%）在 37 周前发生 sPTB。受试者工作特征（ROC）曲线提示，30mm 是预测 35 周前 sPTB 的最佳 CL 截断值（敏感性：43%；特异性：97%）和 37 周前 sPTB（敏感性：21%；特异性：97%）。CL<25mm 是 35 周前 sPTB 的重要危险因素（相对风险：31；95%置信区间：13-73），CL 为 25-30mm 的孕妇发生 sPTB 的风险也较高（相对风险：12；95%置信区间：4-35），与 CL≥30mm 的孕妇相比。
应考虑将孕中期 CL<30mm 作为识别 sPTB 高危妇女的指标。
