利用胎儿纤连蛋白、宫颈Bishop评分及宫颈超声预测足月妊娠分娩时间研究

目的对胎儿纤连蛋白、Bishop宫颈评分及宫颈超声三种预测宫颈成熟和分娩时间的方法进行比较，旨在寻找一种简便、快捷、客观、有效的预测方法。方法选取37～41周无明显剖宫产指征及合并症的孕妇60例，取宫颈阴道分泌物，运用酶联免疫吸附法（ELISA）测定胎儿纤连蛋白（FFN）的浓度。后行阴道超声测量其宫颈长度，最后行宫颈指检，行Bishop宫颈评分。若常规检查及胎儿生物物理评分无异常，则待其自然临产。观察取样及自然临产的间隔时间、产程时间、分娩方式等。结果宫颈阴道分泌物中的FFN浓度、Bishop宫颈评分、阴道超声与临产时间显著相关，且均能预测1周内临产。其中FFN浓度预测1周内临产的敏感性、特异性、阳性预测值和阴性预测值分别为92％、71％、86％、85％，阴道超声预测1周内临产的敏感性，特异度、阳性预测值和阴性预测值分别为88％、67％、76％、81％，Bishop宫颈评分预测1周内临产的敏感性，特异度、阳性预测值和阴性预测值分别为60％、60％、67％、53％。多因素分析显示，FFN预测价值优于阴道超声，而阴道超声优于Bishop宫颈评分。结论FFN、阴道超声、Bishop评分均能预测分娩时间，FFN是宫颈成熟，分娩启动的客观指标，其预测价值最高，如果将FFN，Bishop宫颈评分，宫颈超声三者结合，将大大提高分娩预测的准确性。

A Study on Time Prediction of Term Labot by Using Fetal Fibronectin (fFN) Test, Cervieal Bishop Score and Cervix Ultrasonography

Objective To evaluate and contrast the relationship between the test of fetal gibronectin(fFN), cervical bishop score the cervical length among term pregnant women, in order to find a kind of sample,fast ,accurate and objective method to predict the cervical ripeness and the time of term labor.Methods: The 60 cases term pregnancy women(37~41 weeks) with no obviously cesarean section index and severe complications were chosen as the research subjects, Fetal fibronectin in sample of cervical secretion was tested using enzyme-labeled immunosorbent assay (ELISA) method ,the cervical length was measured by transvaginal ultrasonography, the cervical Bishop score was also determined.Results The levels of cervicovaginal secretions fFN,Bishop score and transvaginal ultrasonographic measurement were significant correlated to the time of parturient respectively. The predictive value for parturition within 7 days by the level of fFN,the sensitivity, specificity, positive value and negative value was 92%,71%,86%,85%respectivity.However,by transvaginal ultrasonographic measurement the predicfire value was 88%,67%,76%,81%.By Bishop score the predictive valne was 60%,60%,67%,53%.Among the several markers in predicting cervix ripening and parfurifion, the best one was the level of fFN, better than transvaginal ultrasonographic and Bishop score.Conclusions Fetal fibronectin is a good marker for cervical maturity,It is more accurate and objective than Bishop score and the measurement of cervical lengths by the transvaginal ultrasonography. If fFN ,Bishop score and cervical ultrasonography are all used, It will more increase the value of predicting delivery.