基层医院采用阴道B超测量宫颈长度在预测早产中的应用价值
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摘要
目的观察不同宫颈长度预测早产的准确性,探究基层医院采用阴道B超测量宫颈长度在预测早产中的应用价值。方法观察90例孕周<37周孕妇孕妇不同孕周宫颈长度,以及经阴道超声测量宫颈长度预测早产的准确性。结果以宫颈25mm为临界值,共有65例孕妇宫颈长度≥25mm,其中足月产60例(92.31%),早产5例(7.69%);宫颈长度<25mm共25例,其中足月产9例(36.00%),早产16例(64.00%)。宫颈长度<25mm的孕妇早产率明显高于≥25mm的孕妇(χ~2=32.0010,P<0.0001),差异具有统计学意义。宫颈长度<25mm敏感度为0.7619,特异性为0.8696,约登指数为0.6315,诊断符合率84.44%。结论经阴道B超测量宫颈长度预测早产准确性较好,适合基层医院临床使用。
Objective To observe the accuracy of different cervical lengths in predicting preterm birth, and to explore the value of using transvaginal B-ultrasound to measure cervical length in predicting preterm delivery. Methods Thecervical length of 90 pregnant women of less than 37 gestational weeks was measured by transvaginal B-ultrasound.Theaccuracy of different cervical lengths in predicting preterm birth was observed. Results Among the 65 pregnant women with cervical length ≥25 mm, there were 60 cases(92.31%) of full-term birth and 5 cases(7.69%) with preterm birth. Among the 25 cases with cervical length <25 mm, there were 9 cases(36.00%)of full-term birth and 16 cases(64%)of preterm birth. The preterm birth rate of pregnant women with cervical length <25 mm was significantly higher than that of pregnant women with cervical length≥25 mm, with statistically significant difference(χ~2=32.0010,P<0.0001). Thesensitivity,specificity,Youden index and diagnostic compliance rate of cervical length <25 mm was 0.7619, 0.8696, 0.6315 and 84.44% respectively. Conclusions The measurement of cervical length by transvaginal B-ultrasound is a good predictor of premature birth and suitable for clinical use in primary hospitals.
Objective To observe the accuracy of different cervical lengths in predicting preterm birth, and to explore the value of using transvaginal B-ultrasound to measure cervical length in predicting preterm delivery. Methods Thecervical length of 90 pregnant women of less than 37 gestational weeks was measured by transvaginal B-ultrasound.Theaccuracy of different cervical lengths in predicting preterm birth was observed. Results Among the 65 pregnant women with cervical length ≥25 mm, there were 60 cases(92.31%) of full-term birth and 5 cases(7.69%) with preterm birth. Among the 25 cases with cervical length <25 mm, there were 9 cases(36.00%)of full-term birth and 16 cases(64%)of preterm birth. The preterm birth rate of pregnant women with cervical length <25 mm was significantly higher than that of pregnant women with cervical length≥25 mm, with statistically significant difference(χ~2=32.0010,P<0.0001). Thesensitivity,specificity,Youden index and diagnostic compliance rate of cervical length <25 mm was 0.7619, 0.8696, 0.6315 and 84.44% respectively. Conclusions The measurement of cervical length by transvaginal B-ultrasound is a good predictor of premature birth and suitable for clinical use in primary hospitals.
引文
[1] 戴晨燕,胡娅莉.超声测量宫颈长度预测早产风险[J].现代妇产科进展,2015,24(8):616-618.
[2] 肖汀,张新玲.超声检查预测早产研究进展[J].中国实用妇科与产科杂,2017,33(2):229-232.
[3] Wozniak S,Czuczwar P,Szkodziak P,et al.Elastography for predicting preterm delivery in patients with short cervical length at 18-22 weeks of gestation:A prospective observational study[J].Ginekol Pol,2015,86(6):442-447.
[4] 王晓怡,陈敦金.宫颈机能不全的孕前诊断方法及评价[J].中国实用妇科与产科杂志,2014,30(2):90-93.
[5] Menon R,Torloni MR,Voltolini C,et al.Biomarkers of spontaneous preterm birth:An overview of the literature in the last four decades[J].Reprod Sci,2011,18(11):1046-1070.
[6] Rao A,Celik E,Poggi S,et al.Cervical length and maternal factors in expectantly managed prolonged pregnancy:Prediction of onset of labor and mode of delivery[J].Ultrasound Obstet Gynecol,2008,32(5):646-651.
[7] 中华医学会妇产科学分会产科学组.早产临床诊断与治疗指南(2014)[J].中华围产医学杂志,2015,18(4):241-245.
[8] Blencowe H,Cousens S,Oestergaard MZ,et al.National,regional,and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries:A systematic analys[J].The Lancet,2012,379(9832):2162-2172.
[9] 余海燕,李维敏,杨太珠.阴道超声监测先兆早产孕妇的宫颈预测其妊娠结局[J].中华围产医学杂志,2001,4(1):10-12.
[10] 张袆,舒群.孕中、晚期阴道超声测量宫颈长度对预测早产的临床价值[J].生殖与避孕,2011,31(6):426-429.
[11] 陈玲,胡继芬,林新霖,等.经阴道超声检测高危孕妇宫颈结构预测早产的研究[J].中国超声医学杂志,2008,24(3):266-269.
[12] Hernandez-Andrade E,Romero R,Korzeniewski SJ,et al.Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery[J].J Perinat Med,2014,42(2):159-169.
[13] 陈一虹,刘兴会.胎盘疾病与早产[J].中国实用妇科与产科杂志,2016,32(4):308-312.
[14] 张晓莉,温龑晨.超声检测宫颈长度预测早产的临床价值[J].医学影像学杂志,2014(4):670-671.
[15] 彭芳华,张志坤,刘雨蒙,等.实时组织弹性成像在妊娠期宫颈评价中的应用[J].国际妇产科学杂志,2015,42(3):352-354.
[16] 曾红艳,曹永政.经阴道超声监测孕妇宫颈形态预测早产的价值[J].临床超声医学杂志,2011,13(10):681-683.
[17] Wesnes SL,Hunskaar S,Bo K,et al.Urinary incontinence and weight change during pregnancy and postpartum:A cohort study [J].Am J Epidemiol,2010,172(9):1034-1044.
[18] Kuuselas P,Jacobsson B,S?derlund M,et al.Transvaginal sonographic evaluation of cervical length in the second trimester of asymptomatic singleton pregnancies,and the risk of preterm delivery[J].Acta Obstet Gynecol Scand,2015,94(6):598-607.
[19] Miller ES,Tita AT,Grobman WA.Second-trimester cervical length screening among asymptomatic women:An evaluation of risk- based strategies[J].Obstet Gynecol,2015,126(1):61-66.
[20] Lim K,Butt k,Crane JM,et al.SOGC clinical practice guideline.Ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies[J].J Obstet Gynaecol Can,2011,33(5):486-499.
[21] 陈雪娟,陈小玲.经会阴超声测量宫颈长度预测早产的价值[J].中华实用诊断与治疗杂志,2014,28(10):1039-1040.
[22] Heath VC,Southall TR,Souka AP,et al.Cervical length at 23 weeks of gestation:Relation to demographic characteristics and previous obstetric history[J].Ultrasound Obstet Gynecol,1998,12(5):304-311.
[23] 曲雪凌.超声在自发性早产预测方面的研究[D].济南:山东大学,2016.
[24] 张志华,朱国平,张伟玲,等.超声下宫颈长度及宫颈指数测定在预测早产中的价值[J].现代妇产科进展,2002,11(1):125-126.
[2] 肖汀,张新玲.超声检查预测早产研究进展[J].中国实用妇科与产科杂,2017,33(2):229-232.
[3] Wozniak S,Czuczwar P,Szkodziak P,et al.Elastography for predicting preterm delivery in patients with short cervical length at 18-22 weeks of gestation:A prospective observational study[J].Ginekol Pol,2015,86(6):442-447.
[4] 王晓怡,陈敦金.宫颈机能不全的孕前诊断方法及评价[J].中国实用妇科与产科杂志,2014,30(2):90-93.
[5] Menon R,Torloni MR,Voltolini C,et al.Biomarkers of spontaneous preterm birth:An overview of the literature in the last four decades[J].Reprod Sci,2011,18(11):1046-1070.
[6] Rao A,Celik E,Poggi S,et al.Cervical length and maternal factors in expectantly managed prolonged pregnancy:Prediction of onset of labor and mode of delivery[J].Ultrasound Obstet Gynecol,2008,32(5):646-651.
[7] 中华医学会妇产科学分会产科学组.早产临床诊断与治疗指南(2014)[J].中华围产医学杂志,2015,18(4):241-245.
[8] Blencowe H,Cousens S,Oestergaard MZ,et al.National,regional,and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries:A systematic analys[J].The Lancet,2012,379(9832):2162-2172.
[9] 余海燕,李维敏,杨太珠.阴道超声监测先兆早产孕妇的宫颈预测其妊娠结局[J].中华围产医学杂志,2001,4(1):10-12.
[10] 张袆,舒群.孕中、晚期阴道超声测量宫颈长度对预测早产的临床价值[J].生殖与避孕,2011,31(6):426-429.
[11] 陈玲,胡继芬,林新霖,等.经阴道超声检测高危孕妇宫颈结构预测早产的研究[J].中国超声医学杂志,2008,24(3):266-269.
[12] Hernandez-Andrade E,Romero R,Korzeniewski SJ,et al.Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery[J].J Perinat Med,2014,42(2):159-169.
[13] 陈一虹,刘兴会.胎盘疾病与早产[J].中国实用妇科与产科杂志,2016,32(4):308-312.
[14] 张晓莉,温龑晨.超声检测宫颈长度预测早产的临床价值[J].医学影像学杂志,2014(4):670-671.
[15] 彭芳华,张志坤,刘雨蒙,等.实时组织弹性成像在妊娠期宫颈评价中的应用[J].国际妇产科学杂志,2015,42(3):352-354.
[16] 曾红艳,曹永政.经阴道超声监测孕妇宫颈形态预测早产的价值[J].临床超声医学杂志,2011,13(10):681-683.
[17] Wesnes SL,Hunskaar S,Bo K,et al.Urinary incontinence and weight change during pregnancy and postpartum:A cohort study [J].Am J Epidemiol,2010,172(9):1034-1044.
[18] Kuuselas P,Jacobsson B,S?derlund M,et al.Transvaginal sonographic evaluation of cervical length in the second trimester of asymptomatic singleton pregnancies,and the risk of preterm delivery[J].Acta Obstet Gynecol Scand,2015,94(6):598-607.
[19] Miller ES,Tita AT,Grobman WA.Second-trimester cervical length screening among asymptomatic women:An evaluation of risk- based strategies[J].Obstet Gynecol,2015,126(1):61-66.
[20] Lim K,Butt k,Crane JM,et al.SOGC clinical practice guideline.Ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancies[J].J Obstet Gynaecol Can,2011,33(5):486-499.
[21] 陈雪娟,陈小玲.经会阴超声测量宫颈长度预测早产的价值[J].中华实用诊断与治疗杂志,2014,28(10):1039-1040.
[22] Heath VC,Southall TR,Souka AP,et al.Cervical length at 23 weeks of gestation:Relation to demographic characteristics and previous obstetric history[J].Ultrasound Obstet Gynecol,1998,12(5):304-311.
[23] 曲雪凌.超声在自发性早产预测方面的研究[D].济南:山东大学,2016.
[24] 张志华,朱国平,张伟玲,等.超声下宫颈长度及宫颈指数测定在预测早产中的价值[J].现代妇产科进展,2002,11(1):125-126.