宫颈环扎术后经阴道超声测量参数对预测早产的临床价值

The clinical value of transvaginal ultrasonography in predicting preterm birth after cervical ligation

目的:探讨宫颈环扎术后1周内经阴道超声参数对早产的预测价值。方法:回顾性分析2018年11月-2019年10月在上海市第一妇婴保健院行宫颈环扎术的157例孕妇,收集孕妇临床资料,随访妊娠结局。比较早产组与足月组孕妇术后1周内的经阴道超声检查参数:宫颈长度、环扎线距内口距离、环扎线距外口距离、有无漏斗部及漏斗部是否见羊膜囊,分析经阴道超声测量参数与早产的相关性。结果:共有119例孕妇符合纳入标准,其中早产组32例(26.9%),足月组87例(73.1%)。两组孕妇宫颈长度、环扎线距内口距离和漏斗部见羊膜囊比较有显著性差异(均P<0.01),环扎线距外口距离比较无显著性差异(P=0.07)。单因素Logistic回归分析显示漏斗部见羊膜囊是早产的最显著影响因素(OR=29.70,95%CI:9.73~90.70,P<0.001),宫颈长度<25 mm和环扎线距内口<15 mm也与早产有明显相关(OR:11.22,95%CI:4.25~29.65,P<0.001;OR:5.70,95%CI:2.29~14.22,P<0.001)。多因素预测模型的Hosmer-Lemeshow拟合优度检验结果显示模型拟合良好,当最佳阈值为0.209时,模型预测早产的敏感度、特异度、约登指数、阳性预测值、阴性预测值和准确率分别为75.0%、93.1%、0.681、80.0%、91.0%、88.2%。结论:在孕妇宫颈环扎术后1周内的经阴道超声检查中,漏斗部见羊膜囊是早产的独立预测指标,宫颈长度<25 mm和环扎线距内口<15 mm对早产也具有一定预测意义。

Objective: To investigate the predictive value of transvaginal ultrasound parameters within one week after cervical cerclage for preterm birth. Methods: A retrospective analysis was performed on 157 pregnant women who underwent cervical cerclage in Shanghai First Maternal and Infant Hospital from November 2018 to October 2019, clinical data were collected and pregnancy outcomes were followed up. The parameters of transvaginal ultrasound within one week after cervical cerclage were compared between the preterm group and the full-term group, including cervical length, cervical length above the stitch, cervical length below the stitch, cervical funneling and the presence of cervical funneling to see the gestational sac.The correlation between transvaginal ultrasound measurement and preterm birth was analyzed. Results: A total of 119 pregnant women met the inclusion criteria, of which 32(26.9%) were in the preterm group and 87(73.1%) were in the full-term group.There were significant differences in the cervical length, the cervical length above the stitch and the cervical funneling of seeing gestational sac between the two groups(P<0.01). The comparisons of the cervical length below the stitch showed no significant difference(P=0.07). Single-factor regression showed the cervical funneling of seeing membranes has the most significant effect on preterm birth(OR=29.70, 95%CI: 9.73~90.70, P<0.001), a total cervical length of less than 25 mm and a proximal cervical length of less than 15 mm are also significantly related to preterm birth(OR: 11.22, 95%CI: 4.25~29.65, P<0.001;OR:5.70, 95%CI: 2.29~14.22, P<0.001). The results of the Hosmer-Leme show fit test of the multi-factor prediction model show that the model fits well, and when the optimal threshold is 0.209, the model predicts the sensitivity, specificity, Jordon index,positive prediction, negative prediction and accuracy of preterm birth are 75.0%, 93.1%, 0.681, 80.0%, 91.0%, 88.2%, respectively. Conclusion: In the transvaginal ultrasound examination of pregnant women within one week after cervical cerclage,the cervical funneling of seeing gestational sac is an independent predictor of preterm birth, a total cervical length of less than 25 mm and a proximal cervical length of less than 15 mm are also predictable for preterm birth.