探讨经腹部与经阴道超声检查诊断孕妇宫颈机能不全的临床价值

Investigation on the clinical value of transabdominal and transvaginal ultrasonography in the diagnosis of cervical incompetence in pregnant women

目的分析孕妇宫颈机能不全采取经腹部与经阴道超声检查的诊断价值。方法110例疑似宫颈机能不全孕妇作为研究对象,均接受经腹部与经阴道超声检查。以临床最终确诊为金标准,比较经腹部超声与经阴道超声对宫颈机能不全的检出率、宫颈内口图像满意率、特异度、敏感度、阳性预测值、阴性预测值、宫颈图像显示率。结果110例疑似宫颈机能不全孕妇中,临床最终确诊104例(94.5%)。经阴道超声的检出率为93.6%、宫颈内口图像满意率为99.1%,均高于经腹部超声的85.5%、90.9%,差异具有统计学意义(P<0.05)。经阴道超声诊断的敏感度98.1%、特异度83.3%、阴性预测值71.4%均高于经腹部超声的85.6%、16.7%、6.3%,差异具有统计学意义(χ^(2)=10.826、5.333、10.729,P<0.05);两种检查方法的阳性预测值比较,差异无统计学意义(χ^(2)=3.147,P>0.05)。经阴道超声诊断的宫颈外口显示率95.5%、宫颈内口显示率94.5%、羊膜囊嵌入宫颈内程度显示率92.7%均高于经腹部超声的88.2%、86.4%、83.6%,差异具有统计学意义(χ^(2)=3.872、4.264、4.362,P<0.05)。结论对孕妇宫颈机能不全采取经腹部与经阴道超声检查,均存在一定的临床应用价值,但经阴道超声的诊断价值更显著。

Objective To analyze the value of transabdominal and transvaginal ultrasonography in the diagnosis of cervical incompetence in pregnant women.Methods There were 110 pregnant women with suspected cervical incompetence as study subjects,and all received transabdominal and transvaginal ultrasonography.Taking the final clinical diagnosis as the gold standard,the detection rate of cervical incompetence,satisfaction rate of cervical image,specificity,sensitivity,positive predictive value,negative predictive value,and display rate of cervical images were compared between transabdominal and transvaginal ultrasonography.Results Among 110 pregnant women with suspected cervical incompetence,104 cases(94.5%)were finally diagnosed clinically.The detection rate 93.6%and satisfaction rate of cervical image 99.1%of transvaginal ultrasonography were higher than 85.5%and 90.9%of transabdominal ultrasonography,and the difference was statistically significant(P<0.05).The specificity 98.1%,sensitivity 83.3%and negative predictive value 71.4%of transvaginal ultrasonography were higher than 85.6%,16.7%and 6.3%of transabdominal ultrasonography,and the difference was statistically significant(χ^(2)=10.826,5.333,10.729,P<0.05).There was no statistically signifiant difference in positive predictive value between two methods(χ^(2)=3.147,P>0.05).The display rate of the external cervix 95.5%and display rate of the internal cervix 94.5%and display rate of the degree of amniotic sac embedded in the cervix 92.7%of transvaginal ultrasonography were higher than 88.2%,86.4%and 83.6%of transabdominal ultrasonography,and the difference was statistically significant(χ^(2)=3.872,4.264,4.362,P<0.05).Conclusion Both transabdominal and transvaginal ultrasonography has certain clinical application value on pregnant women with cervical incompetence,but the diagnostic value of transvaginal ultrasonography is more significant.