Hessami Kamran, Mitts Matthew, Zargarzadeh Nikan, Jamali Marzieh, Berghella Vincenzo, Shamshirsaz Alireza A
Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA (Drs Hessami, Zargarzadeh, Jamali, and Shamshirsaz).
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Dr Mitts).
Am J Obstet Gynecol MFM. 2024 May;6(5S):101172. doi: 10.1016/j.ajogmf.2023.101172. Epub 2023 Sep 30.
This study aimed to examine the association between cervical length and the risk of adverse outcomes in placenta previa pregnancies. In addition, the diagnostic accuracy of cervical length in predicting emergency cesarean delivery due to hemorrhage was evaluated.
PubMed, Web of Science, and Embase were systematically searched up to January 21, 2023.
Observational studies investigating the relationship between cervical length and maternal adverse outcomes in patients with placenta previa were considered eligible. The primary outcome was the diagnostic accuracy of cervical length measured at 28 to 34 weeks of gestation for the prediction of emergency cesarean delivery due to hemorrhage. The secondary outcomes were the probability of antenatal bleeding, preterm birth (both iatrogenic and spontaneous), and postpartum hemorrhage >2000 mL. Insufficient data were available on the transfusion procedure in cases where the cervical length was <30 mm.
For prognostic analysis, the random-effects model was used to pool the odds ratios and the corresponding 95% confidence intervals. For the diagnostic part, we used a summary receiver-operating characteristic curve, pooled sensitivities and specificities, area under the curve, and summary likelihood ratios.
A total of 13 studies presenting data on 1462 pregnancies with placenta previa were included. Cervical length ≤30 mm at 28 to 34 weeks of gestation had a sensitivity of 61% (95% confidence interval, 43-77), specificity of 83% (95% confidence interval, 76-88), and area under the curve of 0.83 (95% confidence interval, 0.80-0.86) for the prediction of emergency cesarean delivery. Furthermore, cervical length ≤30 mm was associated with antenatal bleeding (odds ratio, 3.62; 95% confidence interval, 2.09-6.26; P<.001; I=54.8%), preterm birth (odds ratio, 8.46; 95% confidence interval, 3.05-23.44; P<.001; I=83.6%), and postpartum hemorrhage (odds ratio, 6.89; 95% confidence interval, 4.51-10.53; P<.001; I=0.00%).
Short cervical length (≤30 mm) measured at 28 to 34 weeks of gestation can assist in predicting the risk of emergency cesarean delivery due to hemorrhage in pregnancies with placenta previa. Furthermore, short cervical length is significantly associated with the risk of antenatal bleeding, preterm birth, and postpartum hemorrhage in pregnancies with placenta previa.
本研究旨在探讨前置胎盘妊娠中宫颈长度与不良结局风险之间的关联。此外，还评估了宫颈长度在预测因出血而行急诊剖宫产方面的诊断准确性。
截至2023年1月21日，对PubMed、科学网和Embase进行了系统检索。
调查前置胎盘患者宫颈长度与孕产妇不良结局之间关系的观察性研究被视为符合要求。主要结局是妊娠28至34周时测量的宫颈长度对预测因出血而行急诊剖宫产的诊断准确性。次要结局是产前出血、早产（医源性和自发性）以及产后出血>2000 mL的概率。对于宫颈长度<30 mm的病例，关于输血程序的数据不足。
对于预后分析，采用随机效应模型汇总比值比及相应的95%置信区间。对于诊断部分，我们使用了汇总的受试者工作特征曲线、汇总敏感性和特异性、曲线下面积以及汇总似然比。
共纳入13项研究，提供了1462例前置胎盘妊娠的数据。妊娠28至34周时宫颈长度≤30 mm对预测急诊剖宫产的敏感性为61%（95%置信区间，43 - 77），特异性为83%（95%置信区间，76 - 88），曲线下面积为0.83（95%置信区间，0.80 - 0.86）。此外，宫颈长度≤30 mm与产前出血（比值比，3.62；95%置信区间，2.09 - 6.26；P<.001；I² = 54.8%）、早产（比值比，8.46；95%置信区间，3.05 - 23.44；P<.001；I² = 83.6%）和产后出血（比值比，6.89；95%置信区间，4.51 - 10.53；P<.001；I² = 0.00%）相关。
妊娠28至34周时测量的宫颈长度较短（≤30 mm）有助于预测前置胎盘妊娠因出血而行急诊剖宫产的风险。此外，宫颈长度较短与前置胎盘妊娠的产前出血、早产和产后出血风险显著相关。
