Huang Xiaoxiu, Zhou Yimin, Liu Bingqing, Huang Yuhui, Wang Mengni, Li Na, Li Baohua
Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, Zhejiang, People's Republic of China.
Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou, 310006, Zhejiang, People's Republic of China.
BMC Pregnancy Childbirth. 2024 Oct 1;24(1):621. doi: 10.1186/s12884-024-06822-3.
A short cervix in mid-trimester pregnancy is a risk factor for spontaneous preterm birth. However, there is currently a lack of predictive models and classification systems for predicting spontaneous preterm birth in these patients, especially those without additional risk factors for spontaneous preterm birth.
A retrospective observational cohort study of low-risk singleton pregnant women with a short cervix (≤ 25 mm) measured by transvaginal ultrasonography between 22 and 24 weeks was conducted. A multivariate logistic regression model for spontaneous preterm birth < 32 weeks in low-risk pregnant women with a short cervix was constructed. Moreover, we developed a nomogram to visualize the prediction model and stratified patients into three risk groups (low-, intermediate-, and high-risk groups) based on the total score obtained from the nomogram model.
Between 2020 and 2022, 213 low-risk women with a short cervix in mid-trimester pregnancy were enrolled in the study. Univariate logistic analysis revealed that a high body mass index, a history of three or more miscarriages, multiparity, a short cervical length, leukocytosis, and an elevated C-reactive protein level were associated with spontaneous preterm birth < 32 weeks, but multivariate analysis revealed that multiparity (OR, 3.31; 95% CI, 1.13-9.68), leukocytosis (OR, 3.96; 95% CI, 1.24-12.61) and a short cervical length (OR, 0.88; 95% CI, 0.82-0.94) were independent predictors of sPTB < 32 weeks. The model incorporating these three predictors displayed good discrimination and calibration, and the area under the ROC curve of this model was as high as 0.815 (95% CI, 0.700-0.931). Patients were stratified into low- (195 patients), intermediate- (14 patients) and high-risk (4 patients) groups according to the model, corresponding to patients with scores ≤ 120, 121-146, and > 146, respectively. The predicted probabilities of spontaneous preterm birth < 32 weeks for these groups were 6.38, 40.62, and 71.88%, respectively.
A noninvasive and efficient model to predict the occurrence of spontaneous preterm birth < 32 weeks in low-risk singleton pregnant women with a short cervix and a classification system were constructed in this study and can provide insight into the optimal management strategy for patients with different risk stratifications according to the score chart.
孕中期宫颈短是自发性早产的一个危险因素。然而，目前缺乏用于预测这些患者，尤其是那些没有其他自发性早产危险因素的患者发生自发性早产的预测模型和分类系统。
对22至24周经阴道超声测量宫颈短（≤25mm）的低风险单胎孕妇进行一项回顾性观察队列研究。构建了一个用于预测宫颈短的低风险孕妇<32周发生自发性早产的多因素逻辑回归模型。此外，我们开发了一种列线图以可视化预测模型，并根据从列线图模型获得的总分将患者分为三个风险组（低、中、高风险组）。
在2020年至2022年期间，213名孕中期宫颈短的低风险女性被纳入研究。单因素逻辑分析显示，高体重指数、三次或更多次流产史、多产、宫颈长度短、白细胞增多和C反应蛋白水平升高与<32周的自发性早产相关，但多因素分析显示，多产（比值比[OR]，3.31；95%置信区间[CI]，1.13 - 9.68）、白细胞增多（OR，3.96；95% CI，1.24 - 12.61）和宫颈长度短（OR，0.88；95% CI，0.82 - 0.94）是<32周自发性早产的独立预测因素。纳入这三个预测因素的模型显示出良好的区分度和校准度，该模型的受试者工作特征曲线下面积高达0.815（95% CI，0.700 - 0.931）。根据该模型，患者被分为低风险组（195例患者）、中风险组（14例患者）和高风险组（4例患者），分别对应得分≤120、121 - 146和>146的患者。这些组<32周自发性早产的预测概率分别为6.38%、40.62%和71.88%。
本研究构建了一种用于预测宫颈短的低风险单胎孕妇<32周发生自发性早产的非侵入性有效模型和分类系统，可根据得分图表为不同风险分层的患者提供最佳管理策略的见解。
