超声测量羊水指数和宫颈管长度预测未足月胎膜早破患者分娩潜伏期的价值

Ultrasound measurement of amniotic fluid index and cervical length for predicting delivery latency after preterm premature rupture of membrane

目的:探讨超声测量羊水指数(AFI)和宫颈管长度(CL)预测未足月胎膜早破(PPROM)患者分娩潜伏期的价值。方法:选择2009年10月至2014年10月我院收治的198例PPROM患者,入院后6h内超声检查测量AFI和CL。根据分娩潜伏期分为7日内分娩组和7日后分娩组,比较两组的病史、临床特点及超声指标,评估CL及AFI预测PPROM患者7日内分娩的特异性及敏感性。结果:(1)7日内分娩组患者破膜时伴阴道流血率、破膜时伴有宫缩率和新生儿转NICU率均高于7日后分娩组,差异有统计学意义(P<0.05);(2)7日内分娩组患者的AFI、CL和分娩潜伏期均小于7日后分娩组患者,差异有统计学意义(P<0.05);(3)CL≤2cm联合AFI≤5cm预测PPROM患者7日内分娩具有较高的敏感性及特异性(灵敏度82%,特异度51%);(4)以破膜后7日内是否分娩为应变量,经二分类logistic回归分析显示,破膜时伴阴道流血、破膜时伴有宫缩、CL≤2cm、AFI≤5cm是PPROM后7日内分娩的有效自变量(P<0.05)。结论:超声测量AFI和CL对预测PPROM患者7日内是否分娩有一定价值,TVCL≤2cm联合AFI≤5cm能提高预测PPROM患者7日内分娩的敏感性及特异性。

Objective： To explore the value of ultrasound measurement of amniotic fluid index and cervical length for predicting delivery latency after preterm premature rupture of membrane.Methods： One hundred and ninety-eight PPROM patients were selected.All patients were undergone ultrasound measurement of amniotic fluid index and cervical length within 6hours after admission.According to different delivery latency,patients were divided into two groups：（1） group of delivery within 7 days;（2） group of delivery more than 7 days.Medical history、clinical features、ultrasound features between two groups were compared.Sensitivity and specificity were used to examine whether amniotic fluid index and cervical length can predict delivery within 7 days.Results：（1） The rate of vaginal bleeding、uterine contraction and neonates transferred to NICU in group of delivery within 7 days were higher than those in group of delivery more than 7 days（P〈0.05）;（2） Group of delivery within 7 days had shorter AFI、CL and delivery latency compared with group of delivery more than 7 days;（3） A combination of TVCL≤2cm and AFI≤5cm for predicting delivery latency had higher sensitivity and specificity（82%,51%）;（4） Logistic regression analysis showed that vaginal bleeding 、uterine contraction、CL≤2cm and AFI≤5cm were independent risk factor of delivery within 7 days.Conclusions： Ultrasound measurement of amniotic fluid index and cervical length can predict delivery latency after preterm premature rupture of membrane.The combination of CL≤2cm and AFI≤5cm can improve the sensitivity and specificity.These findings may be helpful for counseling and optimizing maternal and neonatal care in women with PPROM.