经阴道超声孕晚期宫颈弹性成像参数与第一产程时间的相关性研究

Correlation between cervical elastography parameters and time of the first stage of labor in late pregnancy by transvaginal ultrasound

目的探讨孕晚期宫颈组织弹性成像参数与第一产程时间的相关性及各参数间的关系。方法前瞻性收集2018年11月10日至2019年1月30日北京医院的48例足月待产孕妇的临床资料,经阴道实时超声评估宫颈长度(CL)、内口形态,测量宫颈弹性成像参数,包括硬度比(HR)、弹性对比指数(ECI)、宫颈内口应变力平均值(IOS)、宫颈外口应变力平均值(EOS),随访至生产并记录临产后第一产程时间,根据第一产程时间分为第一产程正常组与第一产程延长组。分析评价晚孕期宫颈弹性成像参数与第一产程时间的相关性及各参数间的相关性。结果48例待产孕妇临产后35例经阴道分娩,13例行剖宫产,其中4例因第一产程延长行剖宫产,9例因其他原因行剖宫产。第一产程正常组CL、HR低于第一产程延长组,ECI高于第一产程延长组,差异均有统计学意义(P<0.05);第一产程正常组IOS、EOS均高于第一产程延长组,但差异无统计学意义(P>0.05)。35例临产前行宫颈弹性评估且最终经阴道分娩的孕妇中,第一产程时间与宫颈ECI呈负相关(r=-0.415,P<0.05);ECI与CL、HR呈负相关(r=-0.528,-0.374;均P<0.05);HR与IOS、EOS呈负相关(r=-0.669,-0.558;均P<0.01);HR与CL无明显相关性(P>0.05)。结论超声弹性成像可评价宫颈组织的ECI,或可作为评价宫颈成熟度的半定量指标,对预测产程和指导引产有一定的临床意义。

Objective To investigate the correlations between the labor process and the elastography parameters,and to explore the correlations among the elastography parameters.Methods A total of 48 pregnant women in the late periods of pregnancy in Beijing Hospital from November 10,2018 to January 30,2019 were recruited prospectively.Elastography was performed to measure several elastographic parameters including the cervical length(CL),elasticity contrast index(ECI),hardness ratio(HR),internal orifice uterus(IOS)and external orifice uterus(EOS).They were followed up to delivery,and were divided into normal group and prolonged group according to the time duration of the first stage of labor.The correlation between the parameters and the time duration of the first stage of labor,as well as the relationships among the parameters were evaluated.Results Among the 48 pregnant women,35 cases were delivered by the vagina,13 by cesarean section,4 of whom were due to the prolongation of the first stage of labor and the other 9 cases for other reasons.The values of the CL and HR in normal group were significantly lower than that in prolonged group(P=0.004,0.02).The ECI in the normal group was significantly higher than that in the prolonged group(P=0.046).Both the IOS and EOS in the normal group were higher than those in prolonged group without no significant difference(P>0.05).For the 35 women who underwent cervical elasticity assessment before labor and finally delivered vaginally,the duration of the first stage of labor was negatively correlated with cervical ECI(r=-0.415,P<0.05).The ECI were negatively correlated with CL and HR(r=-0.528,-0.374;P<0.05),and HR were negatively correlated with IOS and EOS(r=-0.669,-0.558;P<0.01),whereas HR had no significant correlation with CL(P>0.05).Conclusions The ECI of cervical tissue measured by cervical elastography can be used to semi-quantitatively evaluate the maturity of the cervix,it has potential value in predicting the labor duration and guiding clinical decision-making.