E-cervix弹性成像评估足月妊娠宫颈成熟度预测阴道分娩的临床价值

Clinical value of E-cervix elastography in assessing cervical maturity of full-term pregnancy

目的应用E-cervix弹性成像技术评估足月妊娠宫颈成熟度,探讨其预测阴道分娩的临床价值。方法选取于我院生产的87例足月孕妇,根据分娩方式分为顺产组(61例)和剖宫产组(26例),应用经阴道超声检查测量宫颈长度;E-cervix弹性成像技术测量宫颈弹性参数,包括硬度比(HR)、弹性对比指数(ECI)、宫颈内口和外口应变值(IOS、EOS)及其比值(IOS/EOS);并进行Bishop评分。比较两组规律宫缩前后宫颈各参数的差异,绘制受试者工作特征(ROC)曲线分析宫颈各参数预测阴道分娩的截断值及其效能。结果两组Bishop评分、HR、IOS、EOS比较差异均有统计学意义(均P<0.05),宫颈长度、ECI、IOS/EOS比较差异均无统计学意义。其中18例孕妇(顺产组12例,剖宫产组6例)在规律宫缩开始与宫颈扩张之间对宫颈弹性进行第2次评估,仅顺产组孕妇在规律宫缩前后HR、IOS、EOS比较差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,以HR 51.94%为截断值,其预测阴道分娩的曲线下面积为0.84,大于宫颈长度及Bishop评分(0.54、0.72)。结论E-cervix弹性成像技术可较为客观、便捷、准确地反映孕晚期宫颈的变化情况,评估宫颈成熟度对临床预测阴道分娩有一定价值。

Objective To explore the clinical value of E-cervix elastography technology in assessing cervical maturity of full-term pregnancy and predicting vaginal delivery.Methods Eighty-seven full-term pregnant women who were delivered in our hospital were selected,they were divided into normal delivery group(61 cases)and the cesarean section group(26 cases)according to the delivery conditions.Transvaginal ultrasound was used to measure cervical length,E-cervix elastography technology was used to measure cervical elastic parameters,including stiffness ratio(HR),elastic contrast index(ECI),internal and external oral strain values(IOS,EOS)and their ratio(IOS/EOS).Bishop score was calculated.The differences of cervical parameters before and after regular contraction between the two groups were compared,and the receiver operating characteristic(ROC)curve was drawn to analyze the cut-off value of each parameter in predicting vaginal delivery and its efficacy.ResultsThere were statistically significant differences in Bishop score,HR,IOS and EOS between the two groups(all P<0.05).However,there were no significant differences in cervical length,ECI and IOS/EOS between the two groups.Among them,18 pregnant women were reassessed of cervical elasticity between the onset of regular contractions and cervical dilation.Only the pregnant women in normal delivery group had statistically significant differences in HR,IOS,and EOS before and after regular contractions(all P<0.05).ROC curve analysis showed that taking HR 51.94%as the cut-off value,the area under the curve for predicting vaginal delivery was 0.84,which was better than that of cervical length and Bishop score(0.54,0.72).Conclusion E-cervix elastography technology can objectively,conveniently and accurately reflect the changes of the cervix in full-term of pregnancy,and can be used as a valuable tool to evaluate cervical maturity.