应用胎儿纤连蛋白选择足月妊娠引产时机

Fetal Fibronectin Test as an Aid in Selection for Term Labor Induction

目的 :探讨宫颈阴道分泌物胎儿纤连蛋白 (fFN)定性测定能否指导足月妊娠引产时机的选择。方法 :6 4例初产、足月、头位、单胎、未破膜、未临产、3日内无同房史、无严重妊娠合并症、并发症 ,在引产开始前行宫颈阴道分泌物fFN定性测定 ,然后肛诊作宫颈Bishop评分 ,选用缩宫素引产。另有 11例符合上述条件的孕妇 ,在引产过程中作fFN测定。结果 :fFN预示引产成功的敏感度 6 1 7% ,特异度 70 5 9% ,阳性预示率 85 2 9% ,阴性预示率 40 0 0 % ,均优于宫颈Bishop评分。fFN(+)组引产成功的时间短于阴性组 ,引产次数也较阴性组少。当fFN(+)、宫颈触诊软时 ,90 9%在 3天内引产成功 ;fFN(+)宫颈不软或fFN(- )、宫颈软时 ,引产成功率降为 80 %左右 ;fFN(- )、宫颈不软时 ,引产的成功率仅为 44 %。在引产过程中测定fFN ,其结果与引产效果基本相符 (8/ 11)。结论 :fFN是反映宫颈成熟度的良好标志 ,较宫颈Bishop评分更正确、客观。定性测定宫颈阴道分泌物fFN可用于指导足月妊娠引产时机的选择 ,将fFN与Bish op评分 ,尤其宫颈的软硬度结合考虑将提高正确性。

Objective:To assess the fFN qualitative test as an aid in selection for right opportunity for induction of term labor.Methods:Sixty four primipara,full term,vertex presentation,singleton gestation,with intact membrines,no regular contractions,no coitus in recent three days,no severe complications were enrolled.Fetal fibronectin was first assayed with cervicovaginal secretions on the day before induction of labor.Digital cervical evaluation were underwent to get Bishop score.Induction of labor was performed with oxytocin.Other 11 cases following induction criteria in addition having been induced labor for several days also entered the study.Results:The sensitivity of fFN for success of inductiforon of labor was 61.7%,specificity 70.59%,positive predictive value 85.29%,negative predictive value 40.00% .The results were better than that of Bishop score.The time of induing labor to starting labor in positive fFN group was shorter than that in negative fFN group.When fFN was (+) and cervix was soft,90.9% of the cases could succeed into labor within 3 days.While fFN was (+) but cervix was not soft or fFN was ( ) but cervix was soft,about 80% of the cases could succeed into labor.When fFN was ( ) and cervix was not soft,44% of the cases could succeed into labor.In 11 cases that received fFN test during induction of labor,8 got expected results.Conclusions:Fetal fibronectin is a good marker for cervical maturity.It is more accurate and objective than Bishop score.Qualitative test of fFN with cervicovaginal samples can be used as an aid in selection right opportunity for induction of term labor.It will be better,if both fFN and Bishop score are used as selection criteria.