胎儿纤连蛋白在预测足月分娩临产启动的观察研究

Observation of fetal fibronectin in predicting initiation of parturition

目的:探讨胎儿纤连蛋白在预测足月分娩临产启动的临床意义。方法:选取我科2010.1-2010.12月间入院足月待产初产孕妇182例,采用ELISA方法测定孕妇宫颈阴道分泌物中的fFN浓度,同时评测Bishop评分,对比两种测定方法对预测足月分娩临产启动的相关性。结果:41周内分娩的孕妇Bishop评分平均值明显高于41w后分娩的孕妇,组间对比P<0.01,但Bishop宫颈评分成熟者仍有相当一部分孕妇分娩启动延迟;FFN预测过期妊娠的特异性为78%,敏感性为91%,阳性预测值为86%,阴性预测值为85%。结论:FFN值预测过期妊娠的敏感性和阴性预测值均优于Bishop评分,特异性和阳性预测值二者一致,且不依赖于临床经验,因此认为fFN值在已达预产期孕妇的宫颈阴道分泌物中含量是分娩启动的有效预测指标。

Objective： To discuss the clinical significance of fetal fibronectin （fFN） in predicting the initiation of parturition. Methods： A total of 182 term prepartal primiparous women admitted to our department from January 2010 to December 2010 were enrolled. The concentration of fFN in cervical and vaginal secretions among pregnant was measured by ELISA method and Bishop scoring was performed on all participants. The correlations of two detection methods in predicting initiation of term parturition were observed for comparison. Results： The Bishop score of pregnant women who had parturition within 41 weeks was remarkably higher than those labored after 41 weeks showing significant difference between the two groups （P〈0.01）. However, among those indicated as mature by Bishop score, there are quite a few had delayed initiation of parturition. Specificity and sensitivity was 78% and 91% respectively using fFN for predicting prolonged pregnancy, while the positive predictive value and negative predictive value was 86% and 85% respectively. Conclusion： The sensitivity and negative predictive value of fFN in predicting prolonged pregnancy is better than that of Bishop score, while the specificity and positive predictive value of two methods are identical and are not correlated with doctors＇ clinical experience. Thus, it is proposed that the concentration of fFN in cervical and vaginal secretions among pregnant women who had reached expected date of delivery is an effective predictor of the initiation of parturition.