Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Center of Fetal Medicine and Pregnancy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Eur J Obstet Gynecol Reprod Biol. 2023 May;284:76-81. doi: 10.1016/j.ejogrb.2023.03.003. Epub 2023 Mar 10.
To examine early pregnancy risk factors for preterm prelabour rupture of membranes (PPROM) and develop a predictive model.
Retrospective analysis of a cohort of mixed-risk singleton pregnancies screened in the first and second trimesters in three Danish tertiary fetal medicine centres, including a cervical length measurement at 11-14 weeks, at 19-21 weeks and at 23-24 weeks of gestation. Univariable and multivariable logistic regression analyses were employed to identify predictive maternal characteristics, biochemical and sonographic factors. Receiver operating characteristic (ROC) curve analysis was used to determine predictors for the most accurate model.
Of 3477 screened women, 77 (2.2%) had PPROM. Maternal factors predictive of PPROM in univariable analysis were nulliparity (OR 2.0 (95% CI 1.2-3.3)), PAPP-A < 0.5 MoM (OR 2.6 (1.1-6.2)), previous preterm birth (OR 4.2 (1.9-8.9)), previous cervical conization (OR 3.6 (2.0-6.4)) and cervical length ≤ 25 mm on transvaginal imaging (first-trimester OR 15.9 (4.3-59.3)). These factors all remained statistically significant in a multivariable adjusted model with an AUC of 0.72 in the most discriminatory first-trimester model. The detection rate using this model would be approximately 30% at a false-positive rate of 10%. Potential predictors such as bleeding in early pregnancy and pre-existing diabetes mellitus affected very few cases and could not be formally assessed.
Several maternal characteristics, placental biochemical and sonographic features are predictive of PPROM with moderate discrimination. Larger numbers are required to validate this algorithm and additional biomarkers, not currently used for first-trimester screening, may improve model performance.
探讨早孕期早产胎膜早破（PPROM）的危险因素，并建立预测模型。
对丹麦三家三级胎儿医学中心的混合风险单胎妊娠进行了队列回顾性分析，在 11-14 周、19-21 周和 23-24 周的妊娠时进行了宫颈长度测量，包括单变量和多变量逻辑回归分析，以确定预测性母体特征、生化和超声因素。采用受试者工作特征（ROC）曲线分析确定最准确模型的预测因子。
在 3477 名筛查妇女中，77 名（2.2%）发生了 PPROM。单变量分析中预测 PPROM 的母体因素为初产妇（OR 2.0（95%CI 1.2-3.3））、PAPP-A<0.5MoM（OR 2.6（1.1-6.2））、既往早产（OR 4.2（1.9-8.9））、既往宫颈锥切（OR 3.6（2.0-6.4））和经阴道超声检查宫颈长度≤25mm（早期妊娠 OR 15.9（4.3-59.3））。这些因素在多变量调整模型中均具有统计学意义，且在最具区分度的早期妊娠模型中 AUC 为 0.72。使用该模型的检出率在假阳性率为 10%时约为 30%。一些潜在的预测因子，如早期妊娠出血和预先存在的糖尿病，影响的病例很少，无法进行正式评估。
一些母体特征、胎盘生化和超声特征可预测 PPROM，具有中等的区分度。需要更多的病例来验证该算法，并且可能需要目前未用于早期妊娠筛查的其他生物标志物来提高模型性能。
