经阴道超声检测高危孕妇宫颈结构预测早产的研究

目的 评价经阴道超声检测宫颈结构在早产高危孕妇中预测早产的价值. 方法:选择50例正常单胎初产妇及50例有早产高危因素的孕妇,分别于孕24、28、32及36周时4次经阴道超声观察其宫颈形态结构变化,并随访妊娠结局. 结果:(1)50例正常孕妇均无早产发生,无宫颈漏斗形成,宫颈长度随妊娠周数增加而缩短,孕32周与孕28周的宫颈长度比较差异有极显著意义,P＜0.01.(2)50例早产高危孕妇中9例发生早产,早产发生率为18%(9/50).9例早产孕妇中有4例宫颈漏斗形成.早产高危孕妇不同孕周的宫颈长度均明显短于相应孕周的正常孕妇的宫颈长度,而孕28周时早产高危孕妇中发生早产的孕妇宫颈长度亦显著短于未发生早产者的宫颈长度,P＜0.01.(3)以正常孕妇孕28周时的宫颈长度x-2s(近似值2.8cm)为临界值,9例早产孕妇孕28周时的宫颈长度均＜2.8 cm,其预测高危孕妇发生早产的敏感性为100%(9/9),特异性为80.5%(33/41),阳性预测值为52.9%(9/17),阴性预测值为100%(33/33). 结论:经阴道超声检测高危孕妇宫颈结构,是NN早产发生的一个客观且有效的指标.     

经会阴超声测量宫颈长度预测早产的价值

目的探讨经会阴超声测量宫颈长度在早产预测中的临床价值。方法孕28~36周行产前检查正常孕妇66例（正常组）,先兆早产孕妇71例（先兆早产组）,均应用经会阴超声测量宫颈长度,随访观察2组妊娠结局,分析宫颈长度与早产的关系。结果正常组均足月顺利分娩,先兆早产组45例足月分娩,26例早产;正常组宫颈长度为（38.9±6.7）mm、先兆早产组足月分娩者和早产者分别为（34.8±8.1）、（25.4±9.2）mm,三者两两比较差异均有统计学意义（P〈0.01）;随宫颈长度缩短,其预测早产的特异度及阳性预测值增高,宫颈〉30mm以上灵敏度明显降低;宫颈长度≤30mm时预测早产的灵敏度为73.1%,特异度为68.9%。26例早产患者中,宫颈长度≤30mm者19例、〉30~35mm者7例,差异有统计学意义（P〈0.01）。结论经会阴超声测量宫颈长度方法简单、方便,宫颈越短早产风险越高,宫颈长度≤30mm可作为预测早产的指标。     

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.     

宫颈结构变化与可溶性细胞粘附分子-1水平对早产预测价值的临床研究

目的研究宫颈结构变化与可溶性细胞粘附分子-1水平(s ICAM-1)对早产预测的价值。方法选取有先兆早产表现孕妇120例进入研究,并选取无先兆早产表现的孕妇80例作为正常对照组进入研究。所有孕妇均行超声检查宫颈结构变化以及用酶联免疫吸附法检测血清s ICAM-1水平。分析宫颈结构变化和s ICAM-1水平与早产之间的关系。结果 1根据分娩结局把有先兆早产表现120例孕妇分为足月分娩组59例和早产组61例。2早产组宫颈长度和s ICAM-1水平分别为(28.45±1.9)mm和(348.32±31.45)ng/ml,宫颈漏斗形成率和宫颈指数分别为60.66%和(0.82±0.04)。早产组宫颈长度小于足月分娩组和正常对照组(均P0.01),而宫颈漏斗发生率、宫颈指数及血清s ICAM-1水平均分别高于足月分娩组和正常对照组(均P0.01)。3ROC曲线分析示,宫颈长度和s ICAM-1的cutoff值分别为29.3 mm和390.1 ng/ml,曲线下的面积分别为0.84和0.79。4以宫颈长度29.3 mm和血清s ICAM-1水平390.1 ng/ml为临界点,联合二者行平行试验,预测早产的灵敏度、特异度、阳性预测值和阴性预测值均在90%以上,Youden指数为0.88,阳性似然比和阴性似然比分别为13.07和0.05。结论宫颈漏斗形成可能增加早产的风险。宫颈长度和血清s ICAM-1水平二者联合检测能有效预测早产。     

超声测量宫颈长度联合血HCG预测早产风险

目的探讨超声测量宫颈长度及血人绒毛膜促性腺激素(HCG)预测早产的临床价值。方法选择孕28+~36+周66例正常产前检查孕妇及71例先兆早产孕妇测量宫颈长度及检测血HCG值,追踪妊娠结局。结果(1)66例正常产前检查孕妇顺利分娩(正常顺产组),71例先兆早产孕妇45例足月分娩(先兆早产组),26例早产(早产组)。(2)先兆早产组及早产组宫颈长度小于或等于30mm的阳性率明显大于正常顺产组,差异有统计学意义(P0.05);先兆早产组及早产组绒毛膜促性腺激素(HCG)升高大于或等于2 MOM的发生率明显大于正常顺产组,差异有统计学意义(P0.05)。(3)宫颈缩短与血HCG升高与早产关系密切,可作为预测早产的指标,两者联合检测提高了单一指标对早产预测的特异度及阳性预测值。结论宫颈长度与血HCG联合检测优于单一的指标对早产的预测,具有一定临床价值。     

探究经阴道超声检测在宫颈形态中预测早产的价值分析

目的:研究并探讨经阴道超声检测宫颈形态对早产的预测价值。方法:于2015年4月~2017年4月期间,选取该阶段内在恩平市人民医院妇产科接受产前检查且存在先兆早产征象的200例孕妇作为研究对象,所有孕妇均接受阴道超声检查,对其宫颈长度进行测量,观察其宫颈内口形态,对孕妇进行动态跟踪随访,对其妊娠结局进行统计。比较不同宫颈长度、不同宫颈内口形态孕妇的早产发生情况,比较早产与足月分娩孕妇的宫颈长度、宫颈内口形态,计算宫颈长度、宫颈内口形态与早产的相关性,计算宫颈长度、宫颈内口形态对早产的预测灵敏度、特异度、准确性。结果:宫颈过短孕妇的早产率明显高于宫颈正常孕妇(P0.05);宫颈内口形态正常孕妇的早产率明显低于宫颈内口形态异常孕妇(P0.05);早产孕妇的宫颈长度明显短于足月分娩孕妇(P0.05),其宫颈内口形态T型占比明显低于足月分娩孕妇(P0.05);宫颈长度、宫颈内口形态与早产密切相关,且呈负相关;宫颈长度对早产的预测灵敏度、特异度、准确性分别为97.37%、94.35%、95.50%,宫颈内口形态分别为96.05%、95.97%、96.00%。结论:经阴道超声检测宫颈长度及宫颈内口形态可对早产进行灵敏预测,宫颈长度、宫颈内口形态可作为早产预测的理想标志物,有利于尽早发现早产风险,及时实施安胎治疗。     

母体血清可溶性细胞间黏附分子-1与早产关系的探讨

目的探讨可溶性细胞间黏附分子-1(sICAM-1)含量与孕妇妊娠结局的相关性,及其在先兆早产及晚期先兆流产诊治中的意义。方法 2011年4月至2012年3月在中山大学附属第一医院产科规律产检并分娩单胎妊娠共73例,分为正常对照组32例,晚期先兆流产及先兆早产41例,其中足月分娩组24例,早产组17例。采用酶联免疫吸附法测定血清sICAM-1,比较组间血清sICAM-1含量差异及其与孕妇早产的关系。结果 (1)早产组sICAM-1浓度高于正常对照组及足月分娩组,早产组宫颈长度小于足月分娩组。(2)sICAM-1浓度、宫颈长度分别达到388.65 ng/ml、21.5 mm时,预测先兆早产及晚期先兆流产孕妇早产的敏感性、特异性、阳性预测值、阴性预测值分别为52.9%、95.7%、90.0%、74.2%,58.8%、91.7%、83.3%、75.9%。(3)以sICAM-1=388.65 ng/ml及宫颈长度21.5 mm为临界点,联合预测晚期先兆流产及先兆早产孕妇早产的敏感性、特异性、阳性预测值、阴性预测值分别为35.3%、87.5%、100%及84%。结论 (1)sICAM-1达到388.65 ng/ml时可预测先兆早产及晚期先兆流产孕妇早产的发生。(2)以sICAM-1=388.65 ng/ml及宫颈长度21.5 mm为临界点,两者联合预测晚期先兆流产及先兆早产孕妇早产可提高阳性预测值及阴性预测值。     

经阴道三维超声评估妊娠期宫颈预测早产的临床价值

目的:研究经阴道三维超声评估妊娠期宫颈对早产预测的临床应用价值。方法:选择200例诊断为先兆早产的患者,经阴道三维超声观察其宫颈形态并随访妊娠结局。结果:与足月产组对比,早产组的宫颈长度、宫颈漏斗出现比、宫颈漏斗口面积等宫颈各项指标差异均有统计学意义(P0.05);宫颈越短、出现宫颈漏斗、漏斗口面积越大的孕妇越容易发生早产。结论:经阴道三维超声评估妊娠期孕妇宫颈结构,是预测早产发生的一个有效手段。     

胎儿纤维连接蛋白和超声测量宫颈长度联合预测早产的临床研究

目的探讨胎儿纤维连接蛋白(fFN)和阴道超声测量宫颈长度联合预测早产的价值及妊娠结局,为临床早产的合理治疗提供理论依据。方法阴道超声动态测量宫颈长度的变化并记录结果。利用美国ADEZA公司生产的fFN测定试剂盒,用酶联免疫吸附(ELISA)法对300例有先兆早产征、既往早产史及多胎妊娠的孕妇进行测定。并追踪病例结果进行分析。结果早产组与足月组fFN测定阳性率和阴道超声测量宫颈长度比较差异有统计学意义。fFN检测联合阴道超声测量宫颈长度预测早产和1周内分娩的敏感度和阳性预测值明显提高。结论 fFN检测联合阴道超声测量宫颈长度对有高危因素的孕妇可有效预测早产的发生,测试结果阳性时,应及时给予干预措施,从而提高早产儿生存率,降低早产儿的病死率及并发症的发生率,测试结果阴性时可以减少过度干预。     

早产筛查与黄体酮阴道用药治疗先兆早产

目的探讨早产筛查与黄体酮阴道用药治疗先兆早产的效果。方法按照随机数字表法将160例有先兆早产征象的孕妇分为A组和B组,各80例,B组孕妇接受常规治疗,A组在此基础上予黄体酮阴道用药;根据孕妇先兆早产情况另将其分为重度先兆早产组(n=61)和中度先兆早产组(n=99);同时将80例正常孕妇归为对照组。对治疗效果、孕妇宫颈长度及胎儿纤维连接蛋白(fFN)进行比较。结果宫颈长度:重度先兆早产组<中度先兆早产组<对照组(P<0.05),fFN检测结果:重度先兆早产组>中度先兆早产组>对照组(P<0.05)。与B组比较,A组分娩孕周、延迟孕周时间、新生儿体质量、足月产率更高,早产率及新生儿窒息率更低(P<0.05)。与对照组比较,A组新生儿体质量更低(P<0.05);B组孕妇分娩孕周、延迟孕周时间、新生儿体质量、足月产率亦更低,但早产率及新生儿窒息率更高(P<0.05)。结论宫颈长度与fFN检测是筛查先兆早产的可靠标志物,应用黄体酮治疗先兆早产效果确切。     

Cervical length evaluation by transvaginal sonography in nongravid women with a history of preterm delivery.

OBJECTIVE: To evaluate cervical length in the nongravid period in women with a past history of preterm delivery. METHODS: The study population comprised 54 women who had delivered spontaneously before 34 weeks of gestation. Etiology of preterm delivery was suspected to be related to cervical incompetence, defined as a painless and progressive dilatation of the cervix in the absence of other causes. Patients with pre-eclampsia, intrauterine growth restriction, uterine anomalies, fetal anomalies, multiple gestation and similar complications were excluded. Shortening of the cervix was recorded during pregnancy in all study patients. One hundred and four women matched for age, parity and body mass index who had given birth at term served as the control group. Cervical length was evaluated in all women at least 12 weeks after delivery by transvaginal sonography in the mid-sagittal plane. RESULTS: The mean gestational age at delivery was 30.8 +/- 1.2 weeks in the study group and 38.8 +/- 2.1 weeks in the control group (P = 0.03). The mean cervical length in the two groups was 36 +/- 6 and 38 +/- 4 mm, respectively. This difference was not statistically significant (P = 0.9). CONCLUSIONS: In nongravid women with unexplained preterm delivery there is no difference in cervical length compared to patients who deliver at term. Shortening of the cervix is most probably a reversible phenomenon that occurs during pregnancy and represents a failure of the competence mechanism to adapt to pregnancy.     

超声检测宫颈长度预测早产的临床价值

目的探讨超声检测宫颈长度（cervicallength,CL）对先兆早产孕妇发生早产的预测价值。方法对2147例单胎先兆早产初产孕妇,分别经腹部、经阴道、经会阴超声检测CL,以CL〈2．6cm为宫颈缩短,追踪妊娠结局,比较三种方法对早产的预测价值。结果经腹部超声检测747例,CL〈2．6cm者早产率40．93％,CL≥2．6cm者早产率4．51％;经阴道超声检测689例,CL〈2．6cm者早产率69．85％,CL≥2．6cm者早产率1．45％;经会阴超声检测711例,CL〈2．6cm者早产率61．54％;CL≥2．6cm者早产率1．98％,三种检测方法检测的CL〈2．6cm组与CL≥2．6cm组的早产率差异均有统计学意义（P〈0．05）;经腹部、经阴道、经会阴超声测量预测早产的敏感性分别为78．57％、92．23％、89．72％,特异性分别为80．00％、93．00％、90．07％,阳性预测值分别为40．93％、69．85％、61．54％,阴性预测值分别为95．49％、98．55％、98．02％,经会阴、经阴道超声测量预测早产的敏感性、特异性、阳性预测值、阴性预测值均显著高于经腹部（P〈0．05）。结论超声检测CL对先兆早产孕妇发生早产有一定的预测意义。经会阴、经阴道超声预测早产的准确性优于经腹部超声。经会阴超声检测可以替代经阴道超声检测,从而提高患者治疗依从性。     

Comparison of transperineal and transvaginal sonography in predicting preterm delivery

PURPOSE: A major advantage of transperineal sonography (TPUS) is its ability to evaluate the cervix without causing any distortion. This study was performed to compare transvaginal sonography (TVUS) and TPUS at 24 weeks of gestation in predicting preterm delivery in low-risk pregnancy. METHODS: Three hundred fifty-seven pregnant women underwent TVUS and TPUS at 24 weeks of gestation. The relationship between cervical length and preterm delivery was assessed. Accuracy values of TVUS and TPUS at 24 weeks of gestation were compared in predicting preterm delivery. RESULTS: Preterm delivery (before 36 weeks of gestation) occurred in 22 pregnancies (6.2%). Mean cervical lengths measured by TVUS and TPUS were significantly different in preterm and term delivery groups (P < 0.05). Areas under the curves were 0.801 and 0.857 for the transvaginal and transperineal measurements, respectively. The coefficient of correlation between the transvaginal and transperineal cervical length measurements was 0.83. TPUS had a sensitivity of 77% in predicting preterm delivery, with a false-positive rate of 17% and a relative risk of 4.5 at the 32.5-mm cutoff value. CONCLUSIONS: When the cervix is well visualized, TPUS can predict preterm delivery as accurately as TVUS.     

Transvaginal sonographic examination of the cervix in asymptomatic pregnant women: review of the literature.

Different strategies have been developed to refine the prediction of the risk of preterm delivery in asymptomatic patients. Transvaginal sonography has been used for this reason to measure and examine the length and shape of the cervix. In this review, we focus on clinical studies involving transvaginal sonographic assessment of the cervix in asymptomatic women at high risk of preterm delivery and in the general pregnant population. Three ultrasound signs are suggestive of cervical incompetence, namely, dilatation of the internal os, sacculation or prolapse of the membranes into the cervix (with shortening of the functional cervical length) either spontaneously or induced by transfundal pressure, and short cervix in the absence of uterine contractions. Transvaginal sonography has clearly demonstrated that cerclage leads to a measurable increase in cervical length which may contribute to the success of this procedure in reducing the risk of preterm delivery. Several non-randomized interventional studies among patients with cervical incompetence have been published. They have defined a new group of patients requiring cerclage when the women show progressive cervical modifications on transvaginal sonography, while in other studies, cerclage performed on the basis of cervical changes on transvaginal sonography did not prevent premature delivery. One prospective randomized trial in asymptomatic high-risk women has shown two benefits of cerclage following indications for transvaginal sonography: (1) it would generate fewer prophylactic cerclages in high-risk women; (2) therapeutic cerclage before 27 weeks may reduce the incidence of premature delivery before 34 weeks. The risk of preterm delivery is inversely correlated with cervical length. Routine transvaginal sonography of the cervix performed between 18 and 22 weeks can help identify patients at risk of preterm delivery. However, given the low prevalence of preterm births, screening would generate either a high false-positive rate or a low sensitivity. One non-randomized interventional study among patients with a short cervix on routine ultrasound examination found a lower risk of delivery before 32 weeks in the cerclage group than in the expectant management group. However, to date, there have been no prospective randomized trials in a general population. Although evidence is still lacking, there does appear to be a benefit in performing a cerclage rather than continuing with expectant management in cases with sonographic appearance of cervical incompetence in asymptomatic women at high risk of preterm delivery. Ultrasound can be offered to reduce the indications of cerclage for cases in which the situation is uncertain. Within the general obstetric population, transvaginal sonography might help in the selection of asymptomatic but high-risk women. However, the benefit associated with cerclage for sonographic indication has not been demonstrated.     

Early prediction of preterm delivery by transvaginal ultrasonography.

The clinical value of transvaginal ultrasonography in the evaluation of the uterine cervix of pregnant women was studied. Comparison with conventional transabdominal ultrasound in 24 pregnant subjects revealed that transvaginal ultrasound was superior, because the transabdominal technique usually requires a full bladder, which causes deformation and elongation of the cervix. Digital examination showed dilatation of the internal os in only ten (38.5%) of 26 patients in whom it had previously been shown by transvaginal sonography. Transvaginal ultrasonography has the advantage of providing natural and objective information on the cervix. The values of three sonographic signs found transvaginally for predicting preterm delivery were evaluated in a total of 130 at-risk patients and 129 control subjects. Shortening of the cervical length by -1.5 SD or more was associated with an increased risk of preterm delivery (11.3% vs. 2.8%, p < 0.01). A dilated internal os of more than 5 mm before 30 weeks of gestation was associated with preterm delivery more often than an undilated internal os (33.3% vs. 3.5%, p < 0.01). Dynamic changes in the degree of dilatation of the cervical canal which were found in nine women were significantly related with preterm delivery (p < 0.05). But, in the at-risk group, only dilatation of the internal os had a predictive value for preterm birth. From these data, dilatation of the internal os on transvaginal ultrasonography was proved to be an early and important predictor of preterm delivery.     

Cervical length at 11-14 weeks' and 22-24 weeks' gestation evaluated by transvaginal sonography, and gestational age at delivery.

OBJECTIVE: To compare cervical length measurements obtained at 11 to 14 weeks and 22 to 24 weeks of gestation in an unselected group of pregnant women and to correlate the measurements with time of delivery. METHODS: This was a prospective study involving 529 pregnant women attending for routine antenatal care who underwent transvaginal scans at 11-14 weeks and 22-24 weeks for evaluation of cervical length. The mean cervical length was calculated at both stages of gestation and lengths were compared between groups which delivered at term or prematurely, this being defined as delivery before 37 completed weeks of gestation. RESULTS: The mean cervical lengths at 11-14 and 22-24 weeks were, respectively, 42.4 mm and 38.6 mm. Cervical length at 11-14 weeks was not significantly different between the groups which delivered at term (42.7 mm) and preterm (40.6 mm). However, at the 22-24-week evaluation, cervical length was significantly shorter in the group which had a preterm delivery than in that which had a term delivery (26.7 mm and 39.3 mm, respectively; P = 0.0001). In the group of women with a previous history of one or more preterm deliveries, there was a greater shortening in cervical length from the first to the second evaluation than there was in the group of women with no previous history of preterm delivery. This shortening was also more pronounced in the group which delivered prematurely (from 40.6 mm to 26.7 mm) than in that which delivered at term (from 42.7 mm to 39.3 mm). CONCLUSION: There is a spontaneous shortening in the pregnant cervix from the first to the second trimester of pregnancy. The shortening is more rapid in pregnant women who deliver prematurely and who have a history of previous preterm delivery.     

Significance of highly phosphorylated insulin-like growth factor binding protein-1 and cervical length for prediction of preterm delivery in twin pregnancies

BACKGROUNDA twin pregnancy can carry greater risks than singleton pregnancies. About 60 in 100 twin pregnancies result in spontaneous birth before 37 wk, which is associated with several complications in the premature babies. Clinical detection of biomarkers may help to predict the possibility of premature birth so that corresponding interventions can be given to the pregnant women in a timely manner, in order to reduce the risk of preterm birth and improve the outcomes of the newborn infants.AIMTo explore the clinical value of transvaginal ultrasound measurement of cervical length combined with insulin-like growth factor binding protein-1 (IGFBP-1) hyperphosphorylation in cervical secretions as predictors of preterm delivery in twin pregnancies.METHODSA total of 254 pregnant women with twin pregnancies, who were admitted to Hainan General Hospital and underwent maternity examination, were selected as the study subjects from January 2015 to December 2018. All participants received transvaginal ultrasound measurement of cervical length and phosphorylated IGFBP-1 (phIGFBP-1) test between 24 and 34 wk gestation. The pregnancy outcomes were analyzed.RESULTSOf the women with a positive phIGFBP-1 test result, preterm birth rate was higher in those with a cervical length ≤ 25 mm than those with a cervical length > 25 mm (all P < 0.05). Similarly, in women with a negative phIGFBP-1 test result, preterm birth rate was higher in those with a cervical length ≤ 25 mm than those with a cervical length > 25 mm (all P < 0.05). The sensitivity, specificity, and positive and negative predictive values of the phIGFBP-1 test combined with the cervical length test were 95.71%, 91.21%, 95.12% and 92.22%, respectively, for the prediction of preterm birth.CONCLUSIONCervical length combined with phIGFBP-1 tests is of value for the prediction of outcomes of preterm delivery in twin pregnancies.     

促肾上腺皮质激素释放激素联合胎儿纤维连接蛋白检测对早产的预测价值

目的 探讨孕妇血浆促肾上腺皮质激素释放激素(CRH)及阴道分泌物中胎儿纤维连接蛋白(fFN)检测联合宫颈长度测量对预测早产的临床价值.方法 采集2009年12月至2010年12月来我院查体孕妇的血浆及阴道分泌物,应用ELISA方法检测CRH和fFN,观察其在妊娠不同时间的变化,并结合不同妊娠结局(早产与足月产)进行分析.结果 112例孕妇早产54例,足月产58例.早产组妊娠24周时宫颈管长度为(2.8±0.4) cm,足月产组为(3.3±0.5) cm,差异有统计学意义(t=3.254,P=0.021).早产组与足月产组妊娠28～ 30周、31 ～32周、33 ～34周、35 ～36周血浆CRH分别为(162.33±16.49)、(60.01±14.56) ng/L,( 352.12±61.01)、(118.04±53.74) ng/L,(364.55±56.71)、(122.95±71.41) ng/L,(372.78±149.89)、(124.00±19.05)ng/L,差异均有统计学意义(t值分别为3.687、6.875、8.652、8.524,P均＜0.05).CRH、fFN联合宫颈长度测定预测早产均有较好的灵敏度(97.92％)、特异度(90.00％)、阳性预测值(95.92％)和阴性预测值(94.73％).结论 检测孕妇CRH、ffN联合宫颈长度测量可以提高对早产的预测性,为早产的早期诊断与治疗提供良好、可靠的临床依据.     

Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies?

OBJECTIVE: To determine whether high-risk patients manifest cervical length < 25 mm on transvaginal ultrasound before 14 weeks of gestation, and if this finding is predictive of preterm delivery. METHODS: Asymptomatic pregnancies at high risk for preterm birth were followed prospectively from 10 + 0 weeks to 13 + 6 weeks with transvaginal sonographic measurement of the cervix. A cervical length < 25 mm was considered a short cervix at this gestational age and at the follow-up ultrasound examinations, performed between 14 and 24 weeks. The primary outcome was preterm birth at < 35 weeks of gestation. RESULTS: One hundred and eighty-three pregnancies met the study criteria and were included in the analysis. Only 10 (5%) patients had a cervix < 25 mm before 14 weeks. The sensitivity, specificity and positive and negative predictive values of a short cervix were 14%, 97%, 50%, and 82%, respectively (relative risk, 2.8; 95% confidence interval, 1.4-5.6). The mean transvaginal sonographic cervical length before 14 weeks of gestation was 33.7 +/- 6.9 mm in pregnancies which delivered preterm (n = 36), and 35.0 +/- 6.8 mm in those delivering at term (n = 147) (P = 0.3). Follow-up transvaginal ultrasound examination of the cervix to 24 weeks revealed that the average gestational age at which a short cervix was detected was 18.7 +/- 2.9 weeks. CONCLUSION: A cervical length < 25 mm on transvaginal sonographic assessment rarely occurs before 14 weeks even in high-risk patients destined to deliver preterm; in these patients cervical changes predictive of preterm birth develop mostly after this gestational age.     

经会阴超声测量子宫宫颈前角及宫颈长度预测早产的应用价值

目的应用经会阴超声测量子宫宫颈前角（ACA）及宫颈长度（CL）,研究ACA、CL在预测早产中的应用价值。 方法选取2018年5月至2019年5月于南京医科大学附属苏州医院产检、孕龄>28周、诊断为先兆早产或存在早产高危因素的孕妇253例。依据妊娠结局,将253例孕妇分为早产组54例,足月产组199例。所有孕妇均行经会阴超声检查,测量ACA与CL,分析早产组与足月产组ACA与CL的差异以及ACA和CL预测早产的效能。 结果本研究早产组CL平均值为（26.18±4.33）mm,小于足月产组的（31.36±3.33）mm,差异有统计学意义（t=8.63,P<0.05）;早产组的ACA平均值大于足月产组［（117.50±9.61）° vs（102.35±7.59）°］,差异有统计学意义（t=-13.428,P<0.05）。本研究253例孕妇,CL预测早产的ROC曲线下面积为0.811（P<0.05）;最佳界值为25.5 mm;其预测早产的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为97.0%、51.9%、82.3%、88.1%、72.4%。ACA预测早产的ROC曲线下面积为0.921（P<0.05）,最佳界值为115.5°,其预测早产的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为83.3%、95.5%、83.3%、95.4%、92.7%。 结论经会阴超声检查测量ACA及CL在预测早产发生中具有一定的临床应用价值,ACA的预测效能略高于CL。经会阴超声操作简便易行、可重复性高,值得临床推广应用。