阴道超声测量子宫颈长度及宫颈管宽度对预测早产的价值

目的　探讨阴道超声测量正常孕妇宫颈长度及宫颈管宽度对先兆早产孕妇发生早产的预测价值。方法　对无任何合并症和并发症的 1 54例正常单胎初产妇 ,于妊娠 1 6～ 35周经阴道超声测量宫颈长度和宫颈管宽度 ,记录宫颈内口有无开大。按孕周不同分成 5组 ,观察不同孕周组孕妇的宫颈变化。同时对 58例有先兆早产症状的孕妇进行宫颈长度及宫颈宽度的超声测量 ,并追踪其妊娠结局。结果　 (1 )正常单胎孕妇各不同孕周组间宫颈长度及宫颈管宽度无明显不同 ,宫颈长度平均为(36± 5)mm ,宫颈管宽度为 (4± 1 )mm ,均无宫颈内口开大。 (2 ) 58例先兆早产孕妇中发生早产的 1 1例为早产组 ,未发生早产的 47例为非早产组。两组孕妇年龄、孕次、出现先兆早产的孕周、保胎的方法及指检宫颈长度比较 ,差异均无显著性 (P >0 0 5)。以宫颈长度 > x - 2s(2 6mm)为界值 ,早产组孕妇的宫颈长度均≤ 2 6mm ,平均为 (1 8± 6)mm ,显著短于非早产组的 (32± 6)mm。两组比较 ,差异有极显著性 (P <0 0 0 1 )。 (3)以宫颈长度≤ 2 6mm为界值 ,预测先兆早产孕妇发生早产的敏感性为1 0 0 % ,特异性为 81 % ,阳性预测值为 55 % ,阴性预测值为 1 0 0 %。结论　经阴道超声检测宫颈长度 ,对先兆早产孕妇发生早产有一定的预测价值 ,先兆早     

胎儿纤维连接蛋白对先兆早产孕妇发生早产的预测价值

目的研究胎儿纤维连接蛋白（fetal fibronectin，fFN）对先兆早产孕妇发生早产的预测价值，及与宫颈长度联合应用时对早产的预测意义。方法联合国内三家医院对有先兆早产症状的孕妇进行阴道后穹窿分泌物中fFN的测定及宫颈的超声检测，追踪这些孕妇的妊娠结局。结果（1）共检测122例先兆早产孕妇，75例fFN阳性，阳性率为61.5％。（2）阳性孕妇中7d内、14d内、37周前分娩率分别为22．7％（17／75）、41．3％（31／75）、65．3％（49／75）；阴性孕妇则分别为0％（0／47）、0％（0／47）、12．8％（6／47）。对于7d内、14d内和37周内分娩的阴性预测值分别为100％、100％和87．2％。（3）50例孕妇同时进行了宫颈长度的测量。以宫颈长度≤26mm为异常。50例中fFN（＋）和宫颈长度同时异常者7d内、14d内、37周前分娩率分别为13．3％（2／15）、40．0％（6／15）、93．3％（14／15），均显著高于fFN（＋）而宫颈长度正常的孕妇。宫颈长度异常而fFN阴性者中无一例14d内分娩。二者同时异常预测先兆早产孕妇发生早产的敏感性为70％，特异性为97．2％，阳性预测值为93．3％，阴性预测值为85．4％。结论（1）在先兆早产孕妇中阴道后穹窿分泌物fFN阳性对先兆早产孕妇发生早产有一定的预测意义，阴性预测短期内不发生早产的价值较大。（2）fFN测定与宫颈长度联合应用可以提高37周前早产阳性预测结果，但对短期内发生早产的预测意义不大。     

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。     

超声下宫颈长度及宫颈指数测定在预测早产中的价值

我们对 1999至 2 0 0 0年在我院产前检查的孕妇 5 0 0例行会阴超声检查 ,以资料完整的 386例为研究对象 ,其中发生先兆早产及早产 5 8例 ,以宫颈长度及宫颈指数作为预测指标 ,研究了它与早产的关系。1　资料与方法1.1　研究对象及方法　以 1999至 2 0 0 0年在本院行产前检查 ,孕龄 2 0～ 37周的孕妇作为筛查对象 ,常规行会阴超声检查 ,以宫颈长度、漏斗长度及宫颈指数为测量参数 ,并追踪孕妇分娩时情况。 (1)宫颈长度 :指宫颈外口至宫颈内口间的距离 ,若宫颈漏斗形成 ,则取漏斗最低点与宫颈外口间距离[1,2 ] ;(2 )漏斗长度 :在宫颈漏斗形成…     

宫颈剪切波E成像技术在预测孕妇早产中的临床运用

目的:探讨宫颈剪切波E成像技术在预测孕妇早产中的临床应用。方法:纳入孕28～32周孕妇,分为无先兆早产组(75例)和先兆早产组(42例)。采用常规二维超声经阴道测量宫颈长度,采用剪切波E成像技术经阴道测量宫颈剪切波速度。结果:先兆早产组的宫颈剪切波速度低于无先兆早产组(P0.001)。先兆早产组孕妇中,经治疗后足月分娩者的宫颈剪切波速度高于治疗后仍早产者(P0.001)。足月分娩者的门诊时宫颈剪切波速度高于最终早产组(P0.001)。门诊时宫颈剪切波预测早产的ROC曲线下面积为0.804(95%CI为0.712～0.897),优于宫颈长度(P=0.035)。治疗后剪切波预测早产的ROC曲线下面积为0.802(95%CI为0.658～0.947),优于宫颈长度(P0.001)。宫颈剪切波速度低于1.385m/s孕妇最终分娩早产的风险是高于1.385m/s孕妇的7.514倍。结论:宫颈剪切波E成像技术有作为临床中预测早产的潜力,且与宫颈长度相比,准确性和特异性更优。     

经阴道与经腹超声检测宫颈长度预测早产的价值

目的 研究超声检测宫颈长度对早产高危孕妇和先兆早产孕妇发生早产的预测价值,并对经阴道和经腹两种方法进行比较.方法 2006年9月至2007年12月在北京四家医院对515例早产高危孕妇和先兆早产孕妇分别经腹和经阴道超声检测宫颈长度,以宫颈长度(cervical length,CL)<3cm为宫颈缩短,追踪妊娠结局,比较两种方法对早产的预测意义.结果 研究对象总的早产率为22.1%(114/515),其中295例经阴道超声检测宫颈长度,220例经腹检测宫颈长度.经阴道测量组早产率为21.4%(63/295),经腹测量组早产率为23.2%(51/220),两组无统计学意义(P=0.622).经阴道测量组CL<3cm者96例,其早产率为36.5%(35/96),CL≥3.0cm者199例,早产率为14.1%(28/199),CL<3cm组早产率显著高于CL≥3.0cm组的早产率(P<0.01).经腹测量组CL<3cm者35例,其早产率为48.6%(17/35)显著高于CL≥3.0cm组孕妇的早产率,其早产率为18.4%(34/185)(P<0.01).经阴道超声测量的CL<3cm预测早产的敏感性为55.6%(35/63),经腹测量预测早产的敏感性为33.3%(17/51).前者显著高于后者(P=0.022).结论 超声检测宫颈长度对早产高危孕妇和先兆早产孕妇发生早产有一定的预测意义,在不能经阴道检测时,经腹测量宫颈长度对早产预测也有一定帮助.     

阴道超声监测先兆早产孕妇的宫颈预测其妊娠结局

目的　评价阴道超声监测宫颈对早产的预测价值。　方法　采用阴道超声对 5 2例先兆早产患者进行宫颈监测以预测保胎治疗后的妊娠结局。超声监测指标为 :宫颈长度、漏斗形成、漏斗长度、漏斗宽度及宫颈指数 [(漏斗长度 1) /宫颈长度 ]。　结果　 5 2例先兆早产患者中 14例发生早产 ,早产的发生率为 2 6 .92 % (14/ 5 2 )。各项超声监测指标均与先兆早产预后显著相关 (P均 <0 .0 0 1) ,而宫颈长度是预测早产的最佳超声指标。制作 ROC曲线 ,结果显示宫颈长度 17mm为最佳临界值 ,预测早产的敏感性为 78.5 7% ,特异性为 86 .84% ,准确性为 84.6 2 %。　结论　应用阴道超声监测宫颈 ,可客观、准确地预测早产。     

宫颈阴道分泌物中的胰岛素样生长因子结合蛋白-1在早产预测中的价值

目的 :探讨宫颈阴道分泌物中高磷酸化的胰岛素样生长因子结合蛋白 - 1(IGFBP- 1)在早产预测中的价值。方法 :应用免疫层析法检测 10 8例孕妇宫颈阴道分泌物中高磷酸化 IGFBP- 1的含量。结果 :先兆早产组、正常妊娠组IGFBP- 1的阳性率分别为 48.2 % (2 7/ 5 6 )和 7.7% (4 / 5 2 ) ,两组结果相比较 ,差异有统计学意义 (P<0 .0 5 )。结论 :宫颈阴道分泌物中的胰岛素样生长因子结合蛋白 - 1可作为早产预测的客观指标     

精子相关抗原9在宫颈腺癌中的表达及其临床意义

目的研究宫颈腺癌组织中精子相关抗原9（SPAG9）的表达及其临床应用价值。方法采用免疫组化链霉亲和素-生物素-过氧化物酶复合物技术（streptavidin biotin-peroxidase complex method,SABC）检测50例宫颈腺癌和18例正常宫颈组织中SPAG9蛋白的表达。结果 SPAG9在宫颈腺癌中的阳性表达率为100%,在正常宫颈组织中表达率为0。根据H-score值,不同病理分级宫颈腺癌中SPAG9表达比较,差异有统计学意义（t=0.661,P〈0.05）,但不同临床分期和盆腔淋巴结转移SPAG9表达比较,差异无统计学意义（t=0.705和1.874,P均〉0.05）。低分化宫颈腺癌患者SPAG9蛋白的表达[（3.25±0.47）分]与高、中分化[（3.18±0.36）分]比较,差异有统计学意义（P〈0.05）。有盆腔淋巴结转患者SPAG9蛋白的表达[（3.39±0.46）分]与无淋巴结转移[（3.18±0.29）分]比较,差异无统计学意义（P〉0.05）;Ⅱ~Ⅳ期宫颈腺癌患者SPAG9蛋白的表达[（3.43±0.42）分]与Ⅰ期[（3.07±0.35）分]比较,差异无统计学意义（P〉0.05）。结论 SPAG9蛋白在宫颈腺癌组织中存在高表达,可能在宫颈腺癌的发生和发展中起重要作用,具有成为其协助诊断和判断预后的分子标志物和靶向治疗靶点的潜能。     

孕中、晚期阴道超声测量宫颈长度对预测早产的临床价值

目的:研究孕中、晚期经阴道超声测量宫颈长度对预测早产的临床价值。方法:回顾性分析无任何严重合并症或并发症的单胎头位初产妇241例(A组),包括早产55例(A1组)、足月产186例(A2组),在孕中期14￣15+6周及23￣24+6周分别行阴道超声测量宫颈长度;另选择同期住院的先兆早产孕妇63例(孕28￣34+6周)(B组)行阴道超声测量宫颈长度。所有对象均于初次产检时取阴道分泌物进行生殖道感染的筛查,分析宫颈长度变化、生殖道感染与早产的关系。结果:①A1组与A2组孕中期不同孕周的宫颈长度组间比较无显著差异(P>0.05),孕23￣24+6周的宫颈长度明显长于孕14￣15+6周的(P<0.05)。63例先兆早产孕妇中,妊娠结局为早产者(B1组)的宫颈长度略短于足月产组(B2组)(P>0.05),但1周后复测宫颈长度的21例中,12例早产者(C1组)宫颈长度的缩短明显大于足月产的9例(C2组),两者间比较有显著性差异(P<0.05)。②A1组的支原体感染率显著高于A2组(P<0.05);A1组合并2种或以上感染者高于B组,组间比较亦有显著性差异(P<0.05)。结论:阴道超声动态检测宫颈可预测早产,但孕中期超声测量宫颈长度对正常孕妇预测早产的意义不大;对先兆早产孕妇发生早产有一定的预测价值。对孕期出现生殖道感染的孕妇尤其是支原体感染或同时存在2种或以上感染者更应加以重视,预防早产。     

Detection of the cervical gland area in threatened preterm labor using transvaginal sonography in the assessment of cervical maturation and the outcome of pregnancy

OBJECTIVES: To detect the cervical gland area in threatened preterm labor, and to determine its detection rate and relationship with cervical maturation and outcome of pregnancy in preterm labor. METHODS: This was a mixed longitudinal and cross-sectional study involving 615 transvaginal scans performed to detect the cervical gland area and measure cervical length in 101 singleton pregnancies with threatened preterm labor. The patients were treated with intravenous administration of ritodrine chloride for regular uterine contractions at 16-35 weeks of gestation. 260 normal singleton pregnancies served as controls. Simultaneously conventional digital examination was used to assess the cervical maturation index. The detection rates of the cervical gland area, measurements of cervical length by sonography, and assessment of the cervical maturation index by digital examination in threatened preterm labor were compared with those of normal singleton pregnancies. In the threatened labor group, the outcome of pregnancy was assessed according to the sonographic absence or presence of the cervical gland area. RESULTS: In the normal pregnancy group, the detection rate of the cervical gland area remained practically constant until the 31st week of pregnancy (97%), but substantially decreased thereafter (70.2% in gestational weeks 32-35). In the threatened preterm labor group, the detection rate of the cervical gland area was constantly lower (44.5%) and the cervical maturation index was higher (4.65 score) than in the normal pregnancy group (83.1% and 1.80 score, respectively). The outcome of pregnancy in the threatened preterm labor group was poorer in the subgroup with the absence of a cervical gland area than in the subgroup with the presence of a cervical gland area (duration of pregnancy 257.0 vs. 271.0 days, birth weight 2,597.2 vs. 2,990.0 g, and admission to delivery interval 38.8 vs. 60.8 days). Highly significant correlations were noted among the detection rates of a cervical gland area and cervical length, cervical maturation index, and outcome of pregnancy. CONCLUSIONS: This study demonstrates for the first time that the sonographic absence of the cervical gland area reflects cervical maturation and could be considered as a predictor of threatened preterm labor and a sign of poor outcome of pregnancy in this condition.     

Transvaginal sonographic assessment of the cervix and preterm labor

OBJECTIVE: The purpose of the study was to assess the accuracy of cervical measurements by transvaginal ultrasonography during the 1st and 2nd trimester in the prediction of preterm labor. STUDY DESIGN: Five hundred high-risk pregnant women in preterm labor were studied retrospectively. RESULTS: A significantly higher percentage rate of preterm delivery was found in women with abnormal cervical length compared to those with normal cervical length (54.6% [118 of 216 women] vs 16.5% [47 of 284 women], p < 0.001). Also in women with abnormal dilatation of the internal cervical os the percentage was significantly higher compared to those with normal findings (78.7% [133 of 216 women] vs. 9.7% [32 of 284 women], p < 0.001). For women with cervical funneling the incidence of preterm delivery was significantly higher compared to the rest of the women (94.3% [33 of 35] vs 28.4% [132 of 465], p = 0.015). CONCLUSION: Our data confirm that sonographic assessment between the 9th and 12th week is the best cut-off period for predicting preterm labor.     

Value of cervical phosphorylated insulinlike growth factor binding protein-1 in the prediction of preterm labor

OBJECTIVE: To determine the value of cervical phosphorylated insulinlike growth factor binding protein-1 (IGFBP-1) in the prediction of preterm labor. STUDY DESIGN: In this prospective study, 77 pregnant women, gestational age 24-36 weeks, were enrolled in the study. Twenty women with completely healthy pregnancies formed the control group. Fifty-seven women with signs and symptoms of preterm labor formed the study group. Phosphorylated IGFBP-1 in cervical secretions was assessed in all patients by using a qualitative, immunochromatographic, 1-step dipstick test. Cervical length was measured by transvaginal sonography. RESULTS: The IGFBP-1 test was negative in all patients in the control group (n = 20), and all of them delivered after 37 weeks, while the test was positive in 15 of 45 (33.3%) patients in the study group. The correlation between cervical length and gestational age at the time of delivery in patients with a positive phosphorylated IGFBP-1 test (n = 15) was significant (r = .553, P = .03). The sensitivity, specificity, positive predictive value and negative predictive value for the phosphorylated IGFBP-1 test were 78%, 87%, 73% and 90%, respectively. CONCLUSION: Use of a 1-step dipstick test for detecting phosphorylated IGFBP-1 in cervical secretions is of value in the prediction of preterm labor. The high negative predictive value of the test may be useful in avoiding unnecessary medical interventions.     

Ultrasonographic measurement of cervical length in twin pregnancies with preterm labor: comparison with singleton pregnancies

OBJECTIVE: Our purpose was to assess the utility of ultrasonographic measurement of cervical length for predicting preterm delivery in pregnant women with twin pregnancy and preterm labor. PATIENTS AND METHOD: Prospective study in 192 singleton and 66 twin pregnancies with preterm labor before 34 weeks. Vaginal sonography for measurement of cervical length, and screening for fetal fibronectin in vaginal smears were performed at admission. The incidence of delivery before 34 weeks was compared with cervical length and the presence of fetal fibronectin. RESULTS: In singleton pregnancies, delivery before 34 weeks was significantly more frequent in women with a cervical length <30 mm (26.6 vs. 2.0%; P = 0.0004), or presence of fetal fibronectin (27.5 vs. 6.0%; P = 0.001). The corresponding negative predictive values (NPV) were 98% and 94%, respectively. In twin pregnancies, receiver characteristic curve analysis showed that a cervical length of 20 mm had the highest diagnostic performance in predicting preterm delivery. The corresponding NPV was 63%. In this group, delivery before 34 weeks showed no significant difference in women with a cervical length < 30 mm (43.7 vs. 38.8%), cervical length < 20 mm (52.0 vs. 36.6%, P = 0.219), or presence of fetal fibronectin (47.6 vs. 21.7%, P = 0.0705). DISCUSSION AND CONCLUSION: Ultrasonographic measurement of cervical length does not predict preterm delivery in twin pregnancies with preterm labor.     

Ⅲ型胶原及CTGF在胎膜早破发病机制中的作用

目的探讨Ⅲ型胶原、结缔组织生长因子（CTGF）在人胎膜组织中的表达及在胎膜早破发病机制中的作用。方法38例胎膜早破孕妇为胎膜早破组，其中未足月胎膜早破组（pPROM组）18例，足月胎膜早破组（tPROM组）20例；与胎膜早破组孕周相对应的非胎膜早破孕妇作为对照组，早产对照组18例，足月对照组20例。应用免疫组化及图像分析法检测胎膜Ⅲ型胶原、CTGF表达水平，以阳性区平均灰度值为检测依据。将各组孕妇胎膜Ⅲ型胶原、CTGF测定结果进行直线相关分析。结果①四组胎膜中均存在不同程度的Ⅲ型胶原、CTGF的表达；②pPROM组Ⅲ型胶原（88．81±5．25）、CTGF水平（85．45±6．91）均低于早产对照组（95．99±8．41，90．30±5．74），差异有统计学意义（P〈0．01，P〈0．05）；tPROM组Ⅲ型胶原（94．53±6．43）、CTGF（88．15±4．93）均低于足月对照组（100．80±9．77，93．20±5．33），（P〈0．05）；pPROM组Ⅲ型胶原（88．81±5．25）表达低于tPROM组（94．53±6．43），两者比较差异有统计学意义（P〈0．01）；pPROM组CT—GF灰度值（85．45±6．91）表达低于tPROM组（88．15±4．93）．但无统计学差异（P〉0．05）；③Ⅲ型胶原、CTGF水平在pPROM组中的表达呈正相关性，r=0．830（P〈0．01），而tPROM组中两者则无相关性。结论pPROM组与tPROM组中存在Ⅲ型胶原与CTGF的低表达。tPROM的发生可能与胎膜的退行性变有关，而pPROM的发生与胎膜本身结构病变密切相关。     

母血浆P-LAP与早产发动关系的相关性临床研究

目的:探讨胎盘亮氨酸氨基肽酶(P-LAP)和白介素-6(IL-6)在正常孕妇和早产孕妇孕晚期(孕28～36+6周)母血浆中的变化趋势。方法:用酶联免疫吸附试验(ELISA法)检测孕晚期孕妇血浆中P-LAP和IL-6含量的变化。结果:(1)P-LAP的浓度随着孕周的增长而不断增加(P<0.01),IL-6的浓度不随着孕周的增长而增加(P>0.05);(2)早产组分别低于先兆早产组和足月组(P<0.01);(3)当早产组P-LAP浓度位于或低于足月组10th百分位水平时,早产发生率比先兆早产组升高(P=0.008),增加了2.15倍的危险度;(4)对研究组血浆P-LAP和IL-6浓度的相关性采用线性回归分析,无明显的相关性(P>0.05)。结论:P-LAP的浓度随着孕周的增长而不断增加,早产孕妇在入院时的血浆P-LAP低水平可以预测其预后。P-LAP水平下降,是早产和正常分娩发动的关键因素之一。     

Prediction and early detection of preterm labor

Studies of cervical sonography, fetal fibronectin, and uterine contraction monitoring during pregnancy have improved our understanding of how preterm labor occurs, but their use in practice remains uncertain. This article reviews the use of these tests to improve the accuracy of diagnosis of preterm labor and to estimate the likelihood of preterm birth in women with historical risk factors. Because the clinical criteria for a diagnosis of preterm labor are inaccurate until labor is well established, over-diagnosis is common. A cervical length measurement of more than 30 mm or a negative fibronectin obtained from a patient with possible preterm labor can avoid over-diagnosis and unnecessary treatment. There is no role for routine use of either cervical sonography or fibronectin to screen pregnant women for preterm birth risk, but women thought to be at increased risk may be reassured by negative test results. Uterine contraction monitoring has low sensitivity for detecting women at risk of preterm birth. Current use of cervical length and fetal fibronectin in pregnancy is limited to situations where a negative result can avoid unnecessary interventions.