胎儿纤维连接蛋白联合宫颈长度测量预测早产的价值

目的 探讨胎儿纤维连接蛋白(fetal fibronectin,fFN)联合宫颈长度测量对先兆早产孕妇发生早产的预测价值.方法 对60例有先兆早产症状的孕妇进行阴道后穹窿分泌物fFN的检测及宫颈的超声测量,并对60例孕妇的妊娠结局进行追踪.结果 1)60例先兆早产孕妇中早产30例(早产组),安胎至足月产30例(足月组).阴道分泌物fFN(+)32例,其中早产组25例,阳性率为78.12%;足月产组7例,阳性率为21.88%,早产组fFN阳性率显著高于足月组(P＜0.05);fFN阳性预测早产的敏感性为83.33%,特异性为76.66%,阳性预测值为78.12%,阴性预测值为82.14%.2)早产组宫颈平均长度为(21.21±6.11)mm,足月产组宫颈平均长度为(29.61±6.71)mm,2组比较差异有统计学意义(P＜0.05).以宫颈长度≤26 mm为临界值,预测早产的敏感性为90.00%,特异性为73.33%,阳性预测值为77.14%,阴性预测值为88.00%.3)fFN阳性和宫颈长度异常者预测早产的敏感性为76.66%,特异性为56.66%,阳性预测值为92.00%,阴性预测值为94.44%.结论 fFN联合宫颈长度测量可以提高对先兆早产孕妇发生早产的阳性预测和阴性预测结果,提高早产预测的准确率.     

Second‐Trimester Genetic Sonography After First‐Trimester Combined Screening for Trisomy 21

Objective. The purpose of this study was to evaluate the trisomy 21 screening performance of the first‐trimester combined test followed by second‐trimester genetic sonography. Methods. This retrospective cohort study included all women with singleton pregnancies undergoing combined screening followed by genetic sonography at 17 to 21 weeks from January 1, 2005, to January 31, 2008. Combined test trisomy 21 risks were multiplied by positive or negative likelihood ratios based on the second‐trimester sonographic findings to determine the final trisomy 21 risk. Sonography was evaluated as the second part of (1) a stepwise sequential test applied to combined screen‐negative pregnancies and (2) an integrated test applied to all combined screen patients regardless of the latter results. A final trisomy 21 risk of 1:270 or higher was considered screen‐positive. Results. A total of 2231 pregnancies underwent combined screening, which detected 7 of 8 Down syndrome cases (87.5%) at a 9.6% screen‐positive rate. A total of 884 of these patients (39.6%), including 2 having fetuses with Down syndrome, had genetic sonography. Combined screening detected 1 of these trisomy 21 fetuses (50%) at a 15.7% screen‐positive rate. Integrated ultrasound‐based aneuploidy screening detected both trisomy 21 cases (100%) at a 22.7% screen‐positive rate, whereas stepwise sequential ultrasound‐based aneuploidy screening also detected both trisomy 21 fetuses (100%) but at a 28.3% screen‐positive rate (P < .0001). Conclusions. Second‐trimester genetic sonography after first‐trimester combined screening may improve trisomy 21 detection at the expense of increasing screen‐positive rates.     

先兆早产孕妇自发性早产发生的影响因素

目的：探讨先兆早产孕妇自发性早产发生的影响因素。方法：回顾性分析广州市增城区人民医院2016年1月~2020年12月收治的86例先兆早产孕妇临床资料,统计自发性早产发生情况,并统计孕妇基线资料,分析先兆早产孕妇发生自发性早产的影响因素。结果：86例先兆性早产孕妇中,发生自发性早产42例（纳入发生组,其余未发生自发性早产的44例孕妇纳入未发生组）,发生率为48.84%;发生组羊水过多、胎膜早破、妊娠期糖尿病、宫颈管长度≤2.5 cm、胎儿纤维连接蛋白（fFN）≥50 ng/ml占比较未发生组高,差异有统计学意义（P＜0.05）;Logistic回归分析结果显示,羊水过多、胎膜早破、妊娠期糖尿病、宫颈管长度≤2.5 cm、fFN≥50 ng/ml可能是先兆早产孕妇发生自发性早产的影响因素（OR＞1,P＜0.05）。结论：先兆早产孕妇发生自发性早产与羊水过多、胎膜早破、妊娠期糖尿病、宫颈管长度≤2.5 cm、fFN≥50 ng/ml密切相关。     

Beyond Cervical Length: A Pilot Study of Ultrasonic Attenuation for Early Detection of Preterm Birth Risk

The purpose of this study was to determine whether cervical ultrasonic attenuation could identify women at risk of spontaneous preterm birth. During pregnancy, women (n = 67) underwent from one to five transvaginal ultrasonic examinations to estimate cervical ultrasonic attenuation and cervical length. Ultrasonic data were obtained with a Zonare ultrasound system with a 5- to 9-MHz endovaginal transducer and processed offline. Cervical ultrasonic attenuation was lower at 17–21 wk of gestation in the SPTB group (1.02 dB/cm-MHz) than in the full-term birth groups (1.34 dB/cm-MHz) (p = 0.04). Cervical length was shorter (3.16 cm) at 22–26 wk in the SPTB group than in the women delivering full term (3.68 cm) (p = 0.004); cervical attenuation was not significantly different at this time point. These findings suggest that low attenuation may be an additional early cervical marker to identify women at risk for SPTB.