Guzman E R, Mellon C, Vintzileos A M, Ananth C V, Walters C, Gipson K
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, St. Peter's Medical Center, New Brunswick 08903-0591, USA.
Obstet Gynecol. 1998 Jul;92(1):31-7. doi: 10.1016/s0029-7844(98)00120-3.
To determine the weekly cervical shortening rates of the endocervical canal between 15 and 24 weeks' gestation in women at risk for pregnancy loss or spontaneous preterm birth.
We performed a retrospective cohort study of transvaginal sonographic measurements of the endocervical canal length done at least twice between 15 and 24 weeks' gestation in women at risk for pregnancy loss and spontaneous preterm birth. The ultrasound diagnosis of cervical incompetence was defined as progressive shortening of the endocervical canal length to 2 cm or less either spontaneously or after application of transfundal pressure. Multivariable linear regression models were developed to determine the weekly crude rate of endocervical canal length shortening rates in cases of competent cervices and incompetent cervices, with incompetent cervices further stratified as those diagnosed at 15-19 weeks' and 20-24 weeks' gestation. Comparisons of the models for weekly rate of endocervical canal length shortening were performed.
The endocervical canal lengths were measured in 61 women (180 measurements) who did not develop ultrasound evidence of cervical incompetence and 28 women (103 measurements) who had ultrasound evidence of cervical incompetence. Between 15 and 24 weeks' gestation, competent cervices had a nonsignificant rate of endocervical canal length shortening (-0.03 cm/week). During this period in gestation, incompetent cervices had significantly greater endocervical canal length shortening (-0.41 cm/week, P < .001). The rate of endocervical canal length shortening of incompetent cervices diagnosed between 15 and 19 weeks' gestation was -0.52 cm/week (P < .001). The rate of endocervical canal length shortening in incompetent cervices diagnosed between 20 and 24 weeks' gestation was significant and varied from -0.49 cm/week to -0.80 cm/week at 20 and 24 weeks' gestation, respectively (P < .001). The models describing the rate of cervical shortening in the two groups of incompetent cervices were significantly different (P < .001). The sonographic detection of endocervical canal length shortening in the 28 cases of cervical incompetence was identified at a median (range) gestational age of 20 (16-24) weeks.
Weekly rates of endocervical canal length shortening were established, which may be useful for detecting and managing cervical incompetence in high-risk women examined with cervical sonography.
确定有妊娠丢失或自发性早产风险的女性在妊娠15至24周期间宫颈管每周的缩短率。
我们对有妊娠丢失和自发性早产风险的女性在妊娠15至24周期间至少进行两次的经阴道超声测量宫颈管长度进行了一项回顾性队列研究。宫颈机能不全的超声诊断定义为宫颈管长度自发缩短至2cm或以下，或在施加经腹压力后缩短至2cm或以下。建立多变量线性回归模型以确定宫颈机能正常和宫颈机能不全情况下宫颈管长度缩短的每周粗率，宫颈机能不全进一步分为在妊娠15 - 19周和20 - 24周诊断出的病例。对宫颈管长度缩短每周率的模型进行比较。
对61名未出现宫颈机能不全超声证据的女性（180次测量）和28名有宫颈机能不全超声证据的女性（103次测量）进行了宫颈管长度测量。在妊娠15至24周期间，宫颈机能正常者宫颈管长度缩短率无统计学意义（-0.03cm/周）。在此妊娠期间，宫颈机能不全者宫颈管长度缩短明显更大（-0.41cm/周，P <.001）。在妊娠15至19周诊断出的宫颈机能不全者宫颈管长度缩短率为-0.52cm/周（P <.001）。在妊娠20至24周诊断出的宫颈机能不全者宫颈管长度缩短率显著，在妊娠20周和24周时分别为-0.49cm/周至-0.80cm/周（P <.001）。描述两组宫颈机能不全者宫颈缩短率的模型有显著差异（P <.001）。28例宫颈机能不全病例中宫颈管长度缩短的超声检测中位（范围）孕周为20（16 - 24）周。
确定了宫颈管长度每周的缩短率，这可能有助于通过宫颈超声检查对高危女性的宫颈机能不全进行检测和管理。
