Department of Ultrasound in Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
J Matern Fetal Neonatal Med. 2024 Dec;37(1):2299111. doi: 10.1080/14767058.2023.2299111. Epub 2024 Jan 10.
This study aimed to investigate changes in the cervical strain rate (SR), cervical length (CL), and uterine artery blood flow parameters during early pregnancy in women with cervical insufficiency and evaluate the clinical efficacy of these markers for screening of cervical insufficiency in early pregnancy.
This retrospective study in 60 pregnant women with cervical insufficiency and 100 normal pregnant women was conducted between September 2021 and January 2023 and measured ultrasound parameters of the cervix during early pregnancy. The cervical SR, CL, and uterine artery resistance index (RI) were measured in both groups at 11-14 weeks of gestation. Strain elastography represented by the SR was used to assess the hardness of the internal and external cervical openings.
During early pregnancy, the SR at the internal and external cervical openings were significantly higher in the cervical insufficiency group than those in the normal pregnancy group (SR : 0.19 ± 0.018% vs. 0.16 ± 0.014%; SR : 0.26 ± 0.028% vs. 0.24 ± 0.025%; < .001). The CL was significantly shorter in the cervical insufficiency group than that measured in the normal pregnancy group (34.3 ± 2.9 mm vs. 35.2 ± 1.99 mm; = .036), while cervical blood perfusion was also poorer in the cervical insufficiency group than that in the normal pregnancy group (uterine artery RI: 0.76 ± 0.07 vs. 0.74 ± 0.05; = .048). Receiver operating characteristic (ROC) curve analysis showed that the optimal critical values for diagnosing cervical insufficiency were 0.17% for SR , 0.25% for SR , 33.8 mm for CL, and 0.78 for uterine artery RI. Of these parameters, the ROC curve for SR had the largest area under the curve [AUC = 0.89 ( < .001)], with the highest sensitivity (78%) and specificity (82%). Multivariate logistic regression analysis demonstrated that the SR at the internal cervical opening (OR 17.47, 95% confidence interval (CI) 5.08-60.08; < .001) and CL (OR 5.05, 95% CI 1.66-15.32; = .004) still showed significant differences between the two groups.
Cervical elastography is an effective tool for screening early pregnancy cervical insufficiency. The SR at the internal cervical opening is a valuable indicator for screening cervical insufficiency and has superior clinical efficacy for screening for this condition compared to that of CL and the uterine artery blood flow index.
本研究旨在探讨宫颈机能不全孕妇妊娠早期宫颈应变率（SR）、宫颈长度（CL）和子宫动脉血流参数的变化，并评估这些标志物在妊娠早期筛查宫颈机能不全的临床效果。
本回顾性研究纳入了 2021 年 9 月至 2023 年 1 月期间 60 例宫颈机能不全孕妇和 100 例正常孕妇，于妊娠早期测量宫颈超声参数。两组孕妇均于 11-14 周时测量宫颈 SR、CL 和子宫动脉阻力指数（RI）。采用以 SR 为代表的应变弹性成像评估内、外宫颈口的硬度。
妊娠早期，宫颈机能不全组内、外宫颈口 SR 明显高于正常妊娠组（SR：0.19±0.018%比 0.16±0.014%；SR：0.26±0.028%比 0.24±0.025%；均<.001）。宫颈机能不全组 CL 明显短于正常妊娠组（34.3±2.9mm 比 35.2±1.99mm；=0.036），宫颈血流灌注也较差（子宫动脉 RI：0.76±0.07 比 0.74±0.05；=0.048）。受试者工作特征（ROC）曲线分析显示，SR 诊断宫颈机能不全的最佳临界值分别为 0.17%、0.25%、33.8mm 和 0.78，其中 SR 的 ROC 曲线下面积最大[AUC=0.89（<.001)]，敏感度（78%）和特异度（82%）最高。多因素 logistic 回归分析显示，内宫颈口 SR（OR 17.47，95%置信区间（CI）5.08-60.08；<.001）和 CL（OR 5.05，95%CI 1.66-15.32；=0.004）在两组间仍有显著差异。
宫颈弹性成像术是筛查妊娠早期宫颈机能不全的有效工具。内宫颈口 SR 是筛查宫颈机能不全的有价值指标，其筛查效果优于 CL 和子宫动脉血流指数。
