阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

Objective To discuss the clinical value of fetal fibronectin (fFN) and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dec. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value (NPV) of fFN in predicting preterm birth within 7 d were 77.4%, 69.4% and 97. 9%, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.60/00, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, and the positive predictive value and specificity can be improved when combined with cervical length.     

早产的预测

早产（pretermlabor，PTL）指妊娠不满37周的分娩，约占分娩总数的5％-15％。尽管围生医学水平有了很大提高，早产仍是新生儿死亡和患病的首要原因。不同国家对早产定义不同，我国目前仍以妊娠满28周至不足37周分娩者称为早产。尽管有些发达国家的学者将早产定义的上限提早到孕20周，但孕24周前的早产儿存活率极低，所以，美国等将妊娠24周至不足37周分娩称为早产。早产儿各器官发育不成熟，因此，早产儿呼吸窘迫综合征、脑室内出血、高胆红素血症、坏死性小肠炎、视网膜病变等发病率增高，     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

Objective To discuss the clinical value of fetal fibronectin (fFN) and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dec. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value (NPV) of fFN in predicting preterm birth within 7 d were 77.4%, 69.4% and 97. 9%, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.60/00, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, and the positive predictive value and specificity can be improved when combined with cervical length.     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

Objective To discuss the clinical value of fetal fibronectin (fFN) and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dec. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value (NPV) of fFN in predicting preterm birth within 7 d were 77.4%, 69.4% and 97. 9%, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.60/00, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, and the positive predictive value and specificity can be improved when combined with cervical length.     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

Objective To discuss the clinical value of fetal fibronectin (fFN) and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dec. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value (NPV) of fFN in predicting preterm birth within 7 d were 77.4%, 69.4% and 97. 9%, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.60/00, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, and the positive predictive value and specificity can be improved when combined with cervical length.     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

目的 探讨阴道分泌物胎儿纤维连接蛋白(fFN)与宫颈长度测量联合应用在早产预测中的价值.方法 选择2006年12月至2007年12月在北京大学第一医院等四家医院就诊的孕22～35周,有不规律宫缩,或有早产高危因素的511例孕妇为研究对象,检测其宫颈阴道分泌物中fFN,同时B超测量宫颈长度,比较其临产的时间及孕周情况.结果 fFN阳性对7 d内分娩预测的敏感度为77.4%,特异度69.4%,阴性预测值97.9%,对34周内分娩预测的敏感度、特异度和阴性预测值分别为70.5%,70.0%,96.2%.宫颈缩短(≤3 cm)者7 d内分娩的敏感度、特异度、阴性预测值分别为54.8%、66.3%、95.8%;对34周内分娩预测的敏感度、特异度和阴性预测值分别为59.1%、67.2%、和94.6%,二者联合7 d内分娩预测敏感度、特异度、阳性预测值和阴性预测值分别为51.6%、87.1%和96.5%;预测34周内分娩的敏感度45.5%,特异度87.6%,阴性预测值94.5%.结论 阴道分泌物fFN比宫颈长度对预测7 d及34周内分娩有较高的阴性预测值及特异度,与超声宫颈长度测量联合应用可进一步提高其阳性预测值和特异度,提高对早产的预测.     

北京地区早产发生现状及早产儿结局的调查分析

目的 探讨北京地区早产发生现状及不同孕周、不同类型早产儿的结局.方法 选择2006年12月1日-2007年5月31日在北京大学第一医院(北大一院)、首都医科大学附属北京妇产医院(市妇产医院)、北京市海淀区妇幼保健院(海淀妇幼)、北京大学第三医院(北大三院)住院分娩的孕28周～36周~(+6)早产产妇955例及其早产儿1066例为研究对象,4家医院同期分娩数为15 197例.结果 (1)早产发生率:早产总发生率为6.3%(955/15 197).其中北大三院的早产发生率为13.1%(150/1142),北大一院的早产发生率为8.1%(125/1549),市妇产医院的早产发生率为5.5%(369/6656),海淀妇幼的早产发生率为5.3%(311/5850).其中北大三院的早产发生率明显高于其他医院(P<0.01).两家综合医院(北大一院及北大三院)的早产率10.2%(275/2691)明显高于两家专科医院(市妇产医院及海淀妇幼)的早产率5.4%(680/12 506),两者比较,差异有统计学意义(P<0.01).(2)早产发生孕周:<34周的早产发生率为28.5%(272/954),≥34周的早产发生率为71.5%(682/954),早产主要发生在孕34周以后.各家医院的早产发生孕周分布有明显不同,其中,海淀妇幼<34周的早产发生率明显低于其他3家医院(P<0.01),北大一院<34周的早产发生率最高(P<0.05),北大三院与市妇产医院相比较,差异无统计学意义(P>0.05).(3)早产发生的原因:在早产的发生原因排序中,未足月胎膜早破(PPROM)早产占首位(405例),其次为医源性早产(340例)和自发性早产(205例).各医院早产发生的原因有所不同,北大三院的医源性早产率明显高于其他各医院(P<0.01);北大一院的PPROM发生率较高而自发性早产率较低.医源性早产的发生原因排序中前4位分别是子痫前期143例(42.0%),胎儿窘迫58例(17.1%),前置胎盘43例(12.6%),胎盘早剥33例(9.7%).(4)各家医院的早产儿结局比较:4家医院由于早产原因、孕周不同,其早产儿结局也存在较大差异,市妇产医院早产儿死亡率最高,为5.4%(22/408),与海淀妇幼(1.3%,4/320)及北大三院(0.6%,1/170)比较,差异有统计学意义(P<0.01);与北大一院(2.4%,3/124)比较,差异无统计学意义(P>0.05).(5)不同孕周的早产儿结局比较:<32孕周的早产儿治愈率显著低于≥32孕周者(P<0.01),≥34孕周的早产儿治愈率为99.6%.<32孕周的早产分娩家属放弃及早产儿死亡率显著高于332孕周者,其中,<32孕周的早产儿死亡率为22.1%,≥34孕周者仅为0.3%,两者比较,差异有统计学意义(P<0.01).(6)不同原因的早产儿结局比较:医源性早产的早产儿死亡率(4.9%)高于PPROM早产(1.6%),两者比较,差异有统计学意义(P<0.05).PPROM、自发性早产及医源性早产3者的早产儿治愈率相互比较,差异无统计学意义(P>0.05).结论 早产儿死亡率较高,尤其是<32孕周的早产儿死亡率更高,这部分早产儿是早产预防的重点;同时,减少医源性早产,积极预防PPROM早产的发生也是降低早产发生率的重要因素.     

早产低危孕妇宫颈长度和胎儿纤连蛋白检测的纵向研究

目的纵向研究早产低危孕妇宫颈长度的孕期变化和胎儿纤连蛋白的状况,为早产预测奠定基础。方法对单胎无早产高危因素和无任何妊娠合并症和严重并发症的初产妇,分别纵向在妊娠22-24周、26-28周、30-32周行后穹隆分泌物胎儿纤连蛋白测定、阴道超声检测宫颈,测量宫颈长度,追踪妊娠结局。结果①共30例完成3个孕期的全部检查,22-24周、26-28周和30-32周胎儿纤连蛋白阳性率分别为：6.7%（2/30）、20.0%（6/30）、16.7%（5/30）;26-28周和30-32周胎儿纤连蛋白阳性者有3例患有阴道炎症;②22-24周、26-28周和30-32周宫颈长度分别为：（3.81±0.26）cm、（3.80±0.36）cm、（3.58±0.32）cm,30-32周的宫颈长度显著短于22-24周和26-28周（P〈0.05）;③30例孕妇中1例在34周发生早产,早产率为3.3%,其胎儿纤连蛋白在26周和31周的检测均为阳性,但宫颈长度正常。其余病历均足月分娩;④1例在30周时宫颈长度为2.7 cm,宫颈长度缩短（〈3.0 cm）的比例为3.3%,该例胎儿纤连蛋白（-）,并且未发生早产。结论早产低危孕妇宫颈长度在30周后有轻微改变;胎儿纤维连接蛋白测定显示出一定比例的假阳性的存在,胎儿纤连蛋白的假阳性可能与阴道炎有关,并有待于进一步研究。     

早产的研究进展(一)

早产是指37周前分娩，是导致新生儿患病和死亡的最常见及最主要的原因。约40％的早产为自发性早产，25％伴随胎膜早破，其余的系医源性早产，由产科因素及合并症等造成。由于早产周数与围产儿的预后密切相关，妊娠32周（尤其34周）后，早产儿存活率及严重并发症发生率明显下降，故国外将早产分为早期早产（early preterm labour）：妊娠满28周至不足32周分娩；中度早产（moderate preterm labour）：妊娠满32周至不足34周分娩；轻度早产（mild preterm labour）：妊娠满34周至36柏周分娩。     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

Objective To discuss the clinical value of fetal fibronectin (fFN) and cervical length in predicting preterm birth. Methods Totally, 511 pregnant women at 22-35 weeks of gestations were enrolled from Dec. 2006 to Dec. 2007 at 4 tertiary hospitals in Beijing, and all with either symptoms or high risk factors of preterm birth, but without preterm premature rupture of membrane or vaginal bleeding. Cervical fFN were determined and cervical length of each subjects were measured by ultrasound. The pregnancy outcomes were compared. Results The sensitivity, specificity and negative predictive value (NPV) of fFN in predicting preterm birth within 7 d were 77.4%, 69.4% and 97. 9%, respectively; and 70.5%, 70.0% and 96.2% for deliveries within 34 weeks. The above figures changed to 54.8%, 66.3%, 95.8% for deliveries within 7 d and 59.1%, 67.2%, 94.6% for those within 34 weeks, respectively, when cervical length ≤3 cm was applied to predict preterm birth. When fFN and cervical length were combined, the sensitivity, specificity and NPV were 51.6%, 87.1%, 96.5% for deliveries within 7 d, and 45.5%, 87.60/00, 94.5% for those within 34 weeks, respectively. Conclusions FFN has higher NPV and specificity than cervical length in predicting preterm birth within 7 d and 34 weeks, and the positive predictive value and specificity can be improved when combined with cervical length.