经阴道超声检查检测宫颈长度及漏斗样变预测未足月胎膜早破高危孕妇发生未足月胎膜早破的价值

Predictive value of detect cervical length and funnel-like changes by transvaginal ultrasonography to predict whether preterm premature rupture of the membrane would occured or not in high risk gravida of preterm premature rupture of the membranes

目的探讨经阴道超声检查（TVS）检测未足月胎膜早破（PPROM）高危人群的宫颈长度及漏斗样变是否可预测PPROM的发生。方法选择2009年6月至2013年12月于天津市中心妇产科医院住院的68例PPROM高危孕妇为研究对象。按照入院后是否发生PPROM,将其分为发生PPROM组（n=28）与未发生PPROM组（n=40）。所有受试者均进行TVS,检测宫颈长度及漏斗样变发生情况。统计学分析两组孕妇宫颈长度及宫颈漏斗样变率差异,并分析不同宫颈长度及漏斗样变率预测PPROM的准确性及其与PPROM发生的关系。本研究遵循的程序符合天津市中心妇产科医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象知情同意,并与之签署临床研究知情同意书。两组孕妇年龄、孕前体质量及入组时孕龄等一般临床资料比较,差异均无统计学意义（P〉0.05）。结果 ①发生PPROM组孕妇的宫颈长度显著短于未发生PPROM组,而宫颈漏斗样变率,则显著高于未发生PPROM组,且差异均有统计学意义（t=2.273,5.909;P〈0.05）。②宫颈长度越短及宫颈漏斗样变率越高,预测发生PPROM的特异度及阳性预测值逐渐升高,宫颈长度〈5mm或75%〈宫颈漏斗样变率≤100%,对预测PPROM的特异度（97.2%及96.3%）及阳性预测值（79.6%及76.3%）最高,并且与PPROM的发生关系最密切（OR=6.47,95%CI：1.33～38.21,P〈0.05;OR=5.80,95%CI：1.11～30.22,P〈0.05）。结论 TVS检测宫颈长度及宫颈漏斗样变,可有效预测PPROM高危人群是否发生PPROM;其中宫颈长度〈5mm及宫颈漏斗样变率〉75%,对发生PPROM的预测价值最高。

Objective To discuss detect cervical length and funnel-like change for preterm premature rupture of the membranes（PPROM）high-risk pregnant women by transvaginal ultrasonography（TVS）to predict the occurrence of PPROM.Methods A total of 68 cases of PPROM high-risk pregnant women hospitalized in Tianjin Central Hospital of Gynecology Obstetrics from June 2009 to December 2013 were selected as study subjects,according to whether PPROM occurred or not after admission,they were divided into PPROM group（n=28）and non PPROM group（n=40）.All subjects were given TVS to detect cervical length and the occurrence of cervical funnel-like changes,statistically analyzed the differences of cervical length and cervical funnel-like change rate of pregnant women between two groups,and the accuracy of different cervical length and funnel-like change to predict occurrence of PPROM and the relationship with PPROM occurrence.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Tianjin Central Hospital of Gynecology Obstetrics.Informed consent was obtained from each participant.There were no significant differences between two groups in general clinical data such as maternal age,pre-pregnant body weight and gestational age（P〉0.05）.Results ①Cervical length of pregnant women of PPROM group was significantly shorter than that of non PPROM group,the cervical funnel-like change rate was significantly higher than that of non PPROM group,and the differences were statistically（t=2.273,5.909;P〈0.05）.② With the length of cervical getting shorter and cervical funnellike change rate getting higher,the prediction specificity and positive predictive value of PPROM increased gradually,and cervical length〈5 mm or 75% 〈funnel-like change rate≤100% had highest prediction specificity of PPROM（97.2% and 96.3%）and positive predictive value（79.6% and 76.3%）,they had the closest relationship with PPROM occurrence（OR=6.47,95%CI：1.33-38.21,P〈0.05;OR=5.80,95%CI：1.11-30.22,P〈0.05）.Conclusion TVS detecting cervical length and cervical funnel-like change can effectively predict the occurrence of PPROM of high risk PPROM pregnant women;Cervical length〈5mm or funnel-like change rate〉75% have the highest prediction value of PPROM occurrence.