Iams J D, Paraskos J, Landon M B, Teteris J N, Johnson F F
Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus.
Obstet Gynecol. 1994 Jul;84(1):40-6.
To improve the accuracy of the diagnosis of preterm labor by comparing transvaginal sonography to digital examination of the cervix.
We performed transvaginal sonography in women with preterm labor who had completed a course of parenteral tocolysis. Cervical length was measured according to criteria reported previously. Cervical sonographic findings were not used in diagnosis or management. Sonographic cervical length was compared to digital assessment of dilation and effacement to assess the risk of preterm birth after treatment for preterm labor.
Forty-eight singleton and 12 twin gestations were studied. Thirty women were nulliparous and 30 were parous. The mean (+/- standard deviation) gestational age was 31.1 +/- 2.7 weeks (range 24-35) at the examination and 35.6 +/- 2.9 weeks (range 26-43) at delivery. Twenty-four subjects delivered before 36 weeks' gestation and 36 delivered at or after 36 weeks. Cervical sonography was distinctly superior to digital assessment of dilation and effacement as a test for delivery before 36 weeks, when compared using receiver operating characteristic curves. This analysis indicated a cervical length of 30 mm as the best cutoff to maximize sensitivity and specificity. All 24 subjects who delivered preterm had cervical lengths less than 30 mm. Cervical sonography was especially useful in selecting women with preterm labor who would not deliver prematurely, ie, a high negative predictive value. None of 15 women whose cervical length was 30 mm or more delivered spontaneously before 36 weeks. CONCLUSION. Among women treated for preterm labor, a cervical length of at least 30 mm predicted a low likelihood of preterm birth. Cervical sonography may improve the accuracy of diagnosis in women treated for preterm labor.
通过比较经阴道超声检查与宫颈指诊来提高早产诊断的准确性。
我们对完成了胃肠外tocolysis疗程的早产女性进行经阴道超声检查。根据先前报道的标准测量宫颈长度。宫颈超声检查结果未用于诊断或治疗。将超声测量的宫颈长度与宫颈扩张和消退的指诊评估结果进行比较，以评估早产治疗后早产的风险。
研究了48例单胎妊娠和12例双胎妊娠。30例为初产妇，30例为经产妇。检查时平均（±标准差）孕周为31.1±2.7周（范围24 - 35周），分娩时为35.6±2.9周（范围26 - 43周）。24名受试者在妊娠36周前分娩，36名在36周及以后分娩。当使用受试者工作特征曲线进行比较时，作为36周前分娩的检测方法，宫颈超声检查明显优于宫颈扩张和消退的指诊评估。该分析表明，宫颈长度30mm是使敏感性和特异性最大化的最佳临界值。所有24例早产的受试者宫颈长度均小于30mm。宫颈超声检查在选择不会早产的早产女性方面特别有用，即具有高阴性预测价值。15例宫颈长度为30mm或更长的女性中，没有一例在36周前自然分娩。结论：在接受早产治疗的女性中，宫颈长度至少30mm预示早产可能性低。宫颈超声检查可能提高接受早产治疗女性的诊断准确性。
