单胎妊娠中宫颈长度与出生时胎龄的关系：巴西人群的多中心前瞻性队列研究。
Association between cervical length and gestational age at birth in singleton pregnancies: a multicentric prospective cohort study in the Brazilian population.
机构信息
Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Campinas, Brazil.
CISAM Maternity Hospital, University of Pernambuco, Recife, Brazil.
出版信息
Reprod Health. 2023 Mar 22;20(1):47. doi: 10.1186/s12978-022-01557-w.
BACKGROUND
Short cervical length measured during the second trimester of pregnancy is an important risk factor for spontaneous preterm birth (sPTB). The aim of this study is to identify the association between mid-pregnancy cervical length (CL) and gestational age at birth in asymptomatic singleton pregnant women.
METHODS
This is a prospective cohort study involving singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial) between July 2015 and March 2019. Transvaginal ultrasound to measure CL was performed from 18 to 22 + 6 weeks. Women with CL ≤ 30 mm received vaginal progesterone (200 mg/day) until 36 weeks' gestation. For this analysis we considered all women with CL ≤ 30 mm receiving progesterone and a random selection of women with CL > 30 mm, keeping the populational distribution of CL. We obtained prognostic effectiveness data (area under receive operating characteristic curve (AUC), sensitivity and specificity and estimated Kaplan-Meier curves for preterm birth using different CL cutoff points.
RESULTS
We report on 3139 women and identified a negative association between cervical length and sPTB. CL ≤ 25 mm was associated with sPTB < 28, sPTB < 34 and sPTB < 37 weeks, whereas a CL 25-30 mm was directly associated with late sPTB. CL by transvaginal ultrasound presented an AUC of 0.82 to predict sPTB < 28 weeks and 0.67 for sPTB < 34 weeks. Almost half of the sPTB occurred in nulliparous women and CL ≤ 30 mm was associated with sPTB at < 37 weeks (OR = 7.84; 95%CI = 5.5-11.1). The number needed to screen to detect one sPTB < 34 weeks in women with CL ≤ 25 mm is 121 and we estimated that 248 screening tests are necessary to prevent one sPTB < 34 weeks using progesterone prophylaxis.
CONCLUSIONS
CL measured by transvaginal ultrasound should be used to predict sPTB < 34 weeks. Women with CL ≤ 30 mm are at increased risk for late sPTB.
背景
妊娠中期测量的短颈长度是自发性早产（sPTB）的重要危险因素。本研究的目的是确定在无症状的单胎孕妇中，中期妊娠宫颈长度（CL）与出生时的孕龄之间的关系。
方法
这是一项前瞻性队列研究，纳入了 2015 年 7 月至 2019 年 3 月期间参加巴西多中心随机对照试验（P5 试验）筛查阶段的单胎孕妇。从 18 至 22+6 周进行经阴道超声测量 CL。CL≤30mm 的孕妇接受阴道孕激素（200mg/天）治疗至 36 周妊娠。对于这项分析，我们考虑了所有接受孕激素治疗且 CL≤30mm 的孕妇，并随机选择了 CL＞30mm 的孕妇，保持 CL 的人群分布。我们获得了预后有效性数据（接受者操作特征曲线下面积（AUC）、敏感性和特异性，并使用不同的 CL 截止值估计了早产的 Kaplan-Meier 曲线。
结果
我们报告了 3139 名妇女的情况，并发现宫颈长度与 sPTB 之间存在负相关。CL≤25mm 与 sPTB＜28、sPTB＜34 和 sPTB＜37 周有关，而 25-30mm 的 CL 与晚期 sPTB 直接相关。经阴道超声的 CL 预测 sPTB＜28 周的 AUC 为 0.82，预测 sPTB＜34 周的 AUC 为 0.67。几乎一半的 sPTB 发生在初产妇中，CL≤30mm 与 sPTB＜37 周有关（OR=7.84；95%CI=5.5-11.1）。在 CL≤30mm 的妇女中，检测到 sPTB＜34 周的 sPTB 数需要 121 次筛查，估计使用孕激素预防需要 248 次筛查来预防 sPTB＜34 周。
结论
经阴道超声测量的 CL 应用于预测 sPTB＜34 周。CL≤30mm 的妇女发生晚期 sPTB 的风险增加。
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