ACA联合CL对早期早产和晚期早产的预测价值

目的分析经会阴部超声测量宫颈前角(ACA)和宫颈管长度(CL)预测早期早产和晚期早产的临床价值。方法回顾性分析2021年1月至2022年12月在本院自发性早产的单胎妊娠孕妇118例,将其分为早期早产组36例(28~33^(+6)周生产)和晚期早产组82例(34~36^(+6)周生产),并随机选取100例足月生产的单胎妊娠孕妇作为对照组,均经会阴部于孕20~28周超声测量ACA和CL,分析ACA和CL与早产和足月产的相关性,以及ACA和CL与早期早产和晚期早产的相关性,并分析两者联合对早产足月产、早期早产晚期早产的预测效能。结果早期早产组、晚期早产组、足月组ACA分别为(112.85±5.96)°、(106.27±7.68)°、(101.79±6.23)°,CL分别为(25.45±4.62)mm、(30.24±5.08)mm、(34.76±3.89)mm,组间比较差异均有统计学意义(P<0.05)。ACA和CL对早产足月产有预测效能;ACA和CL对早期早产和晚期早产也有预测效能(P<0.05),且两者联合预测效能最佳,曲线下面积(AUC)为0.771,敏感性为70.2%,特异性为75.9%。结论妊娠期经会阴部超声测量ACA及CL对早期早产和晚期早产有一定的预测价值,且两者联合预测效能更佳。

Significance of highly phosphorylated insulin-like growth factor binding protein-1 and cervical length for prediction of preterm delivery in twin pregnancies

BACKGROUND A twin pregnancy can carry greater risks than singleton pregnancies.About 60 in 100 twin pregnancies result in spontaneous birth before 37 wk,which is associated with several complications in the premature babies.Clinical detection of biomarkers may help to predict the possibility of premature birth so that corresponding interventions can be given to the pregnant women in a timely manner,in order to reduce the risk of preterm birth and improve the outcomes of the newborn infants.AIM To explore the clinical value of transvaginal ultrasound measurement of cervical length combined with insulin-like growth factor binding protein-1(IGFBP-1)hyperphosphorylation in cervical secretions as predictors of preterm delivery in twin pregnancies.METHODS A total of 254 pregnant women with twin pregnancies,who were admitted to Hainan General Hospital and underwent maternity examination,were selected as the study subjects from January 2015 to December 2018.All participants received transvaginal ultrasound measurement of cervical length and phosphorylated IGFBP-1(phIGFBP-1)test between 24 and 34 wk gestation.The pregnancy outcomes were analyzed.RESULTS Of the women with a positive phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).Similarly,in women with a negative phIGFBP-1 test result,preterm birth rate was higher in those with a cervical length≤25 mm than those with a cervical length>25 mm(all P<0.05).The sensitivity,specificity,and positive and negative predictive values of the phIGFBP-1 test combined with the cervical length test were 95.71%,91.21%,95.12%and 92.22%,respectively,for the prediction of preterm birth.CONCLUSION Cervical length combined with phIGFBP-1 tests is of value for the prediction of outcomes of preterm delivery in twin pregnancies.

Comparison of Bishop score and cervical length measurement through transvaginal ultrasound as prediction against labor induction

Objective:To compare the Bishop score and cervical length measured by transvaginal ultrasound concerned with prediction over the success of labor induction.Methods:This cross-sectional observational analytical study was conducted from May 2017 to October 2017 at several teaching hospitals of Obstetrics and Gynecology Department, Faculty of Medicine Hasanuddin University of Makassar, India. There were 110 samples of pregnant women undergoing labor induction process including 79 samples of successful induction and 31 samples of induction failure. The data analysis used Pearson Chi-square test and multivariate logistic regression to see the effect of Bishop score and measurement of cervical length with successful induction of labor.Results: Number of samples with successful labor induction with Bishop score <3 was 25 (31.6%) and Bishop score≥3 was 54 (68.4%), with rate ratio=3.714 andP=0.000. With measurement of cervical length (cut-off point 2.98 cm), number of samples with successful labor induction with cervical length≤2.98 cm was 12 (15.2%) and cervical length >2.98 cm was 67 (84.8%), with rate ratio=3.124 andP=0.000. Multivahate analysis of logistic regression was found to be more influential in the predicted success of labor induction (P=0.014 with Bishop score <3, odds ratio=1.000 and Bishop score≥3, odds ratio=3.779. Conclusions: Bishop score is better in predicting the success of labor induction compared to the measurement of cervical length through transvaginal ultrasound.

Comparison of transvaginal cervical length and modified Bishop's score as predictors for labor induction in nulliparous women

Objective: To compare the transvaginal cervical length (TVCL) to the modified Bishop's score for prediction of successful labor induction in nulliparous women. Methods: A total of 210 nulliparous women who were diagnosed as premature rupture of membranes were recruited in this comparative prospective study, which was carried out in the Obstetrics and Gynecology Department of Ain Shams University, Egypt over two years for labor induction. The studied women were examined by trans-vaginal ultrasound for measurement of the cervical length (CL) and vaginally to calculate the modified Bishop's score, followed by induction of labor. Collected data were analyzed to compare the TVCL to the modified Bishop's score for prediction of successful labor induction in nulliparous women. The success of induction process was defined as vaginal birth after the induction of labor. Results: One hundred and forty-three women of studied women had CL <28 mm;122 of them delivered vaginally (P=0.030). One hundred and forty-six women of studied women had modified Bishop's score >4;128 of them delivered vaginally (P=0.006). The CL <28 mm was significantly more specific with more positive predictive value as predictor of successful labor induction compared to modified Bishop's score. Induction to delivery time was significantly shorter in women with CL <28 mm than women with CL ≥28 mm (P=0.02;95% confidence interval: 4.9-8.4). In addition, induction to delivery time was significantly shorter in women with Bishop's score >4 than women with Bishop's score of 曑4 (P=0.01;95% confidence interval: 1.6-4.5). Conclusions: Both TVCL and the modified Bishop's score are complementary tools in pre-induction cervical assessment before induction of labor, while the TVCL at <28 mm is significantly more specific with more positive predictive value as predictor of successful induction than the modified Bishop's score.

The Combination of the Fetal Fibronectin Bedside Test and Cervical Length in Preterm Labor Is Useful for Prediction of Preterm Birth

Objective: To determine the value of fetal fibronectin (FFN), cervical length (CL) measurement and their combination as binary predictors for preterm birth (PB) in women with preterm labour (PTL) between 24 + 0 and 34 + 0 weeks. Methods: One hundred fifty-nine patients with signs of PTL (singleton pregnancies (SP) = 125, twin pregnancies (TP) = 34) were evaluated in a retrospective study. Inclusion criteria were contractions > 4/20 min, intact membranes, no bleeding. The cut-off was ≥50 ng/ml for FFN and ≤20 mm for CL measured by transvaginal ultrasound. The primary outcome variable was delivery within 7 days from admission. Results: We evaluated 125 SPs and 34 TPs. In SPs, both methods had a sensitivity of 80%;the specificity was 82% for FFN, and 50% for CL. For the combination of both tests sensitivity was 80% and specificity 88%. In TPs, the sensitivity of both tests was lower (FFN 33%, CL 67%) but the combination of both tests represented the highest result for specificity (77% compared to 68% for FFN alone and 32% for CL alone). Conclusion: The combination of FFN and CL in PTL results in a significant higher specificity in SPs. In TPs the performance of the tests is less accurate.

An implementation study of barriers to universal cervical length screening for preterm birth prevention at tertiary hospitals in Thailand:Healthcare managers’perspectives

Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.

Correlation between Endocervical Length in the First Trimester and Spontaneous Preterm Delivery

Introduction: Prematurity is a public health problem in Brazil, with 12% of deliveries occurring before 37 weeks of gestation. The measurement of the cervix in the second trimester is already established as a method of screening for prematurity and some studies point out advantages to start this screening in the first trimester. Objective: To define the correlation between the length of the endocervix by transvaginal ultrasound in the first trimester (11 to 14 weeks) with spontaneous early deliveries. Method: A prospective and observational study realized in a suplementar and private ultrasound clinic and hospital of Porto Alegre, Brazil between 2019-2020. Ultrasound screening of cervix was performed in singleton pregnancies in first and second trimester of pregnancy and correlated with age of delivery. Results: 142 pregnant women were studied, 80% were in the first pregnancy. The average age was 33.8 years. The rate of prematurity was 18% before 37 weeks and 4% before 34 weeks. The average of cervix measured in the first and second trimesters in deliveries before 34 weeks was 32.7 mm and 29.3 mm, respectively. In term deliveries the median cervical length was 38.8 mm and 37.8 mm, respectively. When analyzing the measurements of the cervix in the second trimester, the cervix was smaller (p = 0.008) among deliveries below 34 weeks (29 mm) than deliveries after 37 weeks. No statistically related differences were found between preterm birth and first trimester cervix measurements. Conclusions: In this study, we did not observe a statistically significant relationship between first trimester cervix measurement and prematurity. More studies are needed to evaluate this finding. However, the measurement of the cervix in the second trimester is different from that found in the literature. This suggests a possible new cut-off point that increases the sensitivity of transvaginal ultrasound as a method of preventing prematurity.

宫颈超声弹性成像对有LEEP史的单胎妊娠孕妇自发性早产的预测价值研究

目的探讨宫颈超声弹性成像对有宫颈环形电刀切除术(loop electrosurgical excision procedure,LEEP)史的单胎妊娠孕妇自发性早产(spontaneous preterm birth,sPTB)预测的有效性。方法选取2020年12月至2022年5月首都医科大学附属北京妇产医院有LEEP史的单胎妊娠孕妇60例,根据分娩孕周是否<37周分为早产组(17例)和对照组(43例)。采用经阴道超声弹性成像测量各项参数,比较两组患者宫颈长度(cervical length,CL)、超声弹性对比指数(elasticity contrast index,ECI)、宫颈硬组织弹性占比(cervical hardness ratio,CHR)、闭合段宫颈内口组织区域应变率(closed internal cervical os strain rate,CIS)、宫颈外口组织区域应变率(external cervical os strain rate,ES)及CIS/ES比值,采用ROC曲线评估宫颈超声弹性成像对有LEEP史的单胎妊娠孕妇sPTB的预测价值。结果60例孕妇年龄25~44岁,平均(33.4±4.4)岁。早产组CL、CHR低于对照组[(2.4±0.9)cm比(2.9±0.6)cm、(58.1±18.6)%比(69.3±15.8)%],CIS高于对照组[(0.3±0.1)%比(0.2±0.1)%],差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,CL+CIS联合指标对有LEEP史的单胎妊娠孕妇sPTB风险预测的AUC为0.746,灵敏度为0.7059,特异性为0.7674,优于单独应用。结论经阴道宫颈超声弹性成像可有效用于有LEEP史的单胎妊娠孕妇sPTB风险的评估。

经会阴超声测量宫颈长度及宫颈前角对孕期经阴道宫颈环扎术后早产的预测价值

目的:探讨经会阴超声测量宫颈长度(CL)及宫颈前角(ACA)对孕期经阴道宫颈环扎术后早产的预测价值。方法:收集2021年1月至2022年6月在郑州大学第一附属医院诊断为宫颈机能不全而行经阴道宫颈环扎术的单胎妊娠孕妇189例,环扎术前24 h内行经会阴超声检查,测量CL及ACA。以CL和ACA为自变量,以是否早产为因变量,进行Logistic回归,构建联合预测模型。绘制ROC曲线,分析环扎术前CL、ACA及两者联合对早产的预测价值。结果:189例中,早产67例(35.4%)。早产组CL小于非早产组[27.00(15.00,34.00)mm vs 32.00(28.75,36.25)mm],ACA大于非早产组[(120.13±11.47)°vs(103.52±17.44)°](P均<0.05)。CL、ACA及两者联合预测环扎术后早产的AUC(95%CI)分别为0.679(0.596~0.762)、0.792(0.727~0.856)、0.813(0.749~0.877),ACA及CL联合ACA的AUC大于CL(P<0.05)。结论:经会阴超声测量ACA可辅助CL预测孕期经阴道宫颈环扎术后早产的发生。

孕中期超声宫颈管长度联合血清白蛋白检测对双胎妊娠早产的预测价值

目的 探讨孕中期超声宫颈管长度(CL)联合血清白蛋白(ALB)检测对双胎妊娠早产的预测价值。方法 回顾性分析2019年3月—2022年6月在安徽医科大学附属宿州医院定期产检的113例双胎妊娠孕妇的临床资料,依据是否发生早产分为早产组和非早产组,分别有31和82例。对比两组孕妇的临床资料、超声CL、血清ALB水平。多因素逐步Logistic回归模型分析双胎妊娠早产的相关因素。绘制受试者工作特征(ROC)曲线,评价超声CL、血清ALB及两者联合预测双胎妊娠早产的价值。结果 两组孕妇年龄、孕前BMI、检查孕周、孕产史、受孕方式、合并妊娠期糖尿病、合并妊娠期高血压、Hb、WBC、PLT、TC、TG、Scr及BUN比较,差异均无统计学意义(P>0.05)。早产组胎膜厚度大于非早产组(P <0.05),单绒毛膜双羊膜囊占比高于非早产组(P <0.05)。早产组超声CL短于非早产组(P <0.05),血清ALB水平低于非早产组(P <0.05)。多因素逐步Logistic回归分析,结果显示:胎膜厚度厚[O^R=2.901(95%CI:1.047,8.039)]、超声CL短[O^R=0.299(95%CI:0.108,0.828)]、血清ALB水平低[O^R=0.309(95%CI:0.112,0.857)]是影响双胎妊娠孕妇早产发生的危险因素(P <0.05)。ROC曲线分析结果显示,超声CL、血清ALB及两者联合对双胎妊娠早产预测的敏感性分别为83.87%(95%CI:0.655,0.939)、87.10%(95%CI:0.692,0.958)、80.65%(95%CI:0.619,0.919),特异性分别为87.80%(95%CI:0.783,0.937)、71.95%(95%CI:0.608,0.810)、98.78%(95%CI:0.925,0.999),曲线下面积分别为0.896(95%CI:0.825,0.946)、0.811(95%CI:0.726,0.878)、0.910(95%CI:0.841,0.955)。结论 孕中期超声CL、血清ALB联合检测对双胎妊娠早产的预测效能较高。

宫颈前角、宫颈长度及剪切波速度在宫颈机能不全自发性早产风险中的预测价值研究

目的分析宫颈前角(Anterior uterocervical angle,ACA)、宫颈长度(Cervical length,CL)及剪切波速度(Shear wave velocity,SWV)在宫颈机能不全自发性早产风险中的联合预测价值。方法以2023年2月-6月在南京医科大学第二附属医院妇产科建档的376例宫颈机能不全孕妇为研究对象,分析不同孕周(19~23 w+6 d、24~27 w+6 d、28~33 w+6 d、34~36 w+6 d)时ACA、CL、SWV与孕周的相关性。对所有孕妇随访至完成分娩,根据孕妇是否早产分为早产组与非早产组,比较2组孕妇的一般资料。经Logistic回归分析宫颈机能不全孕妇早产的风险因素,根据危险因素构建预测模型,采用受试者工作特征(Receiver operating characteristic curve,ROC)曲线分析ACA、CL、SWV对宫颈机能不全孕妇自发性早产风险的单独及联合预测效能,采取Pearson相关性分析ACA、CL及SWV与宫颈机能不全孕妇孕周的相关性。结果不同孕周的宫颈机能不全孕妇SWV、CL间,差异有统计学意义(P<0.05),且随着孕周增加SWV、CL呈下降趋势(P<0.05),不同孕周的宫颈机能不全孕妇比较,ACA差异无统计学意义(P>0.05)。Pearson相关性分析结果表明,SWV、CL与宫颈机能不全孕妇的孕周呈负相关关系(r=-0.628、-0.867,P<0.05)。ACA与宫颈机能不全孕妇的孕周无相关性(r=0.109,P=0.081)。376例孕妇中自发性早产79例,自发性早产率为21.01%(79/376),足月产297例,足月产率为78.99%(297/376)。将79例自发性早产孕妇纳入早产组,其余297例足月产孕妇分为非早产组,经单因素分析表明,两组年龄、BMI、流产次数、辅助生殖技术妊娠情况、孕周,差异无统计学意义(P>0.05),与非早产组比较,早产组ACA升高,CL、SWV降低(P<0.05)。Logistic回归分析表明ACA、CL、SWV均是导致宫颈机能不全孕妇自发性早产的重要风险因素(P<0.05),建立早产联合预测模型:Logistic(P)=-48.126+6.059×SWV+0.206×CL+0.295×ACA;ROC曲线分析表明,ACA、CL、SWV对宫颈机能不全孕妇自发性早产的单独预测灵敏度分别为82.90%、68.30%、80.50%,ACA+CL+SWV联合预测灵敏度为93.90%。结论ACA、CL、SWV在宫颈机能不全孕妇自发性早产风险中具有一定预测价值,3个指标联合预测的敏感度与准确度较高。

颈椎退行性疾病前路手术后住院时间延长的影响因素

目的 分析颈椎退行性疾病前路手术后住院时间(LOS)延长的影响因素。方法 2018年1月—2022年1月嘉定区中医医院及海军军医大学长征医院采用颈椎前路手术治疗颈椎退行性疾病患者241例。收集患者的基本情况、手术情况及术后情况相关参数,并通过相关分析探索影响LOS与术后LOS的因素。结果 根据术式分组,颈椎前路椎体次全切除融合术(ACCF)组与颈椎前路椎间盘切除融合术(ACDF)组LOS与术后LOS差异无统计学意义(P > 0.05);2组疾病诊断、手术节段、手术时间、出血量、引流时间、第1天引流量及第2天引流量差异均有统计学意义(P < 0.05)。根据疾病诊断分组,脊髓型颈椎病(CSM)组LOS、术后LOS显著长于神经根型颈椎病(CSR)组,差异均有统计学意义(P < 0.05)。相关分析结果显示,疾病诊断、糖尿病、手术时间、出血量、ICU治疗与LOS及术后LOS存在相关性。结论 CSM患者的LOS、术后LOS显著长于CSR患者。此外,合并糖尿病、手术时间长、出血量大、ICU治疗可能是LOS、术后LOS延长的影响因素。

双胎妊娠产妇不良妊娠结局的影响因素及相关因素对其的预测价值

目的:研究双胎妊娠产妇不良妊娠结局的影响因素,以及宫颈管长度、血清白蛋白、体重增长情况对双胎妊娠产妇不良结局的预测价值。方法:选取2021年3月—2023年2月瑞金市妇幼保健院接诊的102例双胎妊娠产妇,比较两组临床资料、宫颈管长度、血清白蛋白水平等,根据妊娠结局将其分为不良妊娠结局组(n=50)、正常组(n=52)。采用logistic回归分析法分析双胎妊娠产妇不良妊娠结局的影响因素,绘制受试者操作特征(ROC)曲线分析宫颈管长度联合血清白蛋白、体重增长情况预测双胎妊娠产妇不良妊娠结局的效能。结果:102例研究对象中共有50例出现不良妊娠结局,发生率为49.02%。两组年龄、体重增长、血清白蛋白、宫颈管长度比较,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,年龄是双胎妊娠产妇不良妊娠结局的危险因素,体重增长、血清白蛋白、宫颈管长度是双胎妊娠产妇不良妊娠结局的保护因素(P<0.05)。ROC曲线显示,宫颈管长度联合血清白蛋白、体重增长情况预测双胎妊娠产妇不良妊娠结局的AUC为0.916。结论:宫颈管长度、血清白蛋白、体重增长是双胎妊娠产妇不良妊娠结局的保护因素,三者联合检测预测双胎妊娠产妇不良妊娠结局的效能较高。

Fast acquisition of L2C CL codes based on combination of hyper codes and averaging correlation

This paper provides a direct and fast acquisition algorithm of civilian long length（CL） codes in the L2 civil（L2C） signal. The proposed algorithm simultaneously reduces the number of fast Fourier transformation（FFT） correlation through hyper code technique and the amount of points in every FFT correlation by using an averaging correlation method. To validate the proposed acquisition performance, the paper applies this algorithm to the real L2C signal collected by the global positioning system（GPS） L2C intermediate frequency（IF） signal sampler—SIS100L2C. The acquisition results show that the proposed modified algorithm can acquire the code phase accurately with less calculation and its acquisition performance is better than the single hyper code method.

Cervical Characterization with Tactile-Ultrasound Probe

Background: Premature cervical softening and shortening may be considered an early mechanical failure that predisposes to preterm birth. Preliminary clinical studies demonstrate that cervical elastography may be able to quantify this phenomenon and predict spontaneous preterm delivery. Objective: To explore a new approach for cervix elasticity and length measurements with tactile-ultrasound probe. Methods: Cervix probe has tactile array and ultrasound transducer designed to apply controllable load to cervix and acquire stress-strain data for calculation of cervical elasticity (Young’s modulus) and cervical length for four cervix sectors. Average values, standard deviations, intraclass correlation coefficients and the 95% limits of agreement (Bland-Altman plots) were estimated. Results: Ten non-pregnant and ten pregnant women were examined with the probe. The study with non-pregnant women demonstrated a reliable acquisition of the tactile signals. The ultrasound signals had a prolonged appearance;identification of the internal os of the cervix in these signals was not reliable. The study with pregnant women with the gestational age of 25.4 ± 2.3 weeks demonstrated reliable data acquisition with real-time visualization of the ultrasound signals. Average values for cervical elasticity and standard deviations of 19.7 ± 15.4 kPa and length of 30.7 ± 6.6 mm were calculated based on two measurements per 4 sectors. Measurement repeatability calculated as intraclass correlation coefficients between two measurements at the same cervix sector on pregnant women was found to be 0.97 for cervical elasticity and 0.93 for the cervical length. The 95% limits of agreement of 1) cervical elasticity were from ?22.4% to +14.9%, and 2) cervical length from ?13.3% to +16.5%. Conclusions: This study demonstrated clinically acceptable measurement performance and reproducibility. The availability of stress-strain data allowed the computation of cervical elasticity and length. This approach has the potential to provide cervical markers to predict spontaneous preterm delivery.

Reporting cervical effacement as a percentage: How accurate is it?

Objective: To evaluate the accuracy of cervical effacement reported as a percentage by digital cervical exams using cervical length determined by transvaginal ultrasonography as a standard. Methods: Records of pregnant women who had a digital cervical exam and subsequent transvaginal ultrasound scan for cervical length between January 2005 and December 2008 were reviewed. Digital cervical exams were performed by different examiners. Transvaginal ultrasound was performed by one examiner who did not perform any of the digital exams. Cervical effacements were recorded as a percentage and cervical lengths were measured in centimeters. Results: A total of 173 women met the study criteria. Average cervical length for 0% effacement was 3.3 ± 1.1 cm (0.8 - 5.0 cm);20% effacement, 1.6 ± 1.0 cm (0.9 - 3.0 cm);25% effacement, 2.2 ± 0.2 cm (2.0 - 2.3 cm);30% effacement, 2.6 ± 0.4 cm (2.1 - 3.0 cm);40% effacement, 3.0 ± 0.4 cm (2.6 - 3.4 cm);50% effacement, 2.4 ± 1.1 cm (0.6 - 4.6 cm);60% effacement, 2.3 ± 1.4 cm (0.7 - 4.3 cm);70% effacement, 2.2 ± 0.8 cm (1.1 - 3.3 cm);75% effacement, 1.7 ± 1.4 cm (0.7 - 2.7 cm);80% effacement, 2.0 ± 0.9 cm (0.6 - 4.4 cm);90% effacement, 0.7 ± 0.4 cm (0.4 - 0.9 cm);100% effacement, 1.2 ± 1.5 cm (0.3 - 3.0 cm). The coefficient of variation ranges from 10% - 124%. Conclusion: The traditional method of reporting cervical effacement as a percentage is unacceptably inaccurate compared to the actual cervical length determined by vaginal probe ultrasound.

Examination of Potential Energy Curves of CFCl by Multi-reference Configuration Interaction Method

We give a detailed examination of potential energy curves of the singlet and triplet states of CFC1 correlated with the lowest three dissociation limits. The calculations are carried out at the internally contracted multi- reference configuration interaction/cc-pV（T＋d）Z level with the other two geometric parameters fixed at the state equilibrium conformation. The vertical transition energy, the oscillator strength, the main configuration and the electron transition are also investigated at the same level.

单胎妊娠短宫颈的临床观察

目的 探讨单胎妊娠短宫颈患者宫颈环扎术的有效性和安全性。方法 选取2019年1月至2021年1月在首都医科大学附属北京妇产医院进行产前检查,有过1次孕晚期流产史或早产史或孕期常规超声提示宫颈缩短孕妇128例,根据治疗方法进行分组,有过1次孕晚期流产史或早产史孕妇42例,其中宫颈环扎组30例,药物治疗组12例。单纯短宫颈的孕妇86例,其中宫颈环扎组18例,药物治疗组68例。比较不同治疗方法的流产率、早产率,分娩孕周、延长孕周、新生儿窒息等妊娠结局。结果 有过1次孕晚期流产史或早产史的孕妇中,宫颈环扎组与药物治疗组相比,早产、流产发生率更低,并能更明显延长孕周,甚至接近足月分娩,差异均有显著性(P<0.05),而两组孕妇在新生儿窒息、产后出血和宫颈裂伤方面比较差异无显著性(P>0.05)。对于单纯短宫颈孕妇,宫颈环扎组与药物治疗组的流产、早产、新生儿窒息及产后出血发生率和分娩孕周、延长孕周上比较差异均无显著性(P>0.05),且两组均无宫颈裂伤。结论 有过1次孕晚期流产史或早产史的孕妇,需要定期监测宫颈长度,如果宫颈进行性缩短应及时给予宫颈环扎术。对于单纯短宫颈的孕妇,定期监测宫颈长度,如宫颈没有极短,药物治疗同样可得到良好的妊娠结局,同时避免了手术带来的风险。宫颈环扎术要掌握好指征。

孕中晚期子宫颈长度缩短差值及胎盘下缘增厚差值对严重产后出血风险的评估研究

目的探讨孕中、晚期子宫颈长度(CL)缩短差值及胎盘下缘增厚差值对严重产后出血(PPH)风险的评估价值。方法选取2020年1月至2021年7月于本院妇产科接受手术分娩的21例完全性前置胎盘孕妇作为研究对象,按照末次腹部B超显示CL分为CL正常组(n=8,CL≥30 mm)与CL缩短组(n=13,CL<30 mm),比较两组预后情况(产前出血、急诊剖宫产、PPH),分析PPH严重程度,比较严重PPH与非严重PPH患者孕中、晚期胎盘下缘厚度及CL变化,绘制ROC曲线分析孕中、晚期CL缩短差值、胎盘下缘厚度差值对严重PPH的预测价值。结果CL正常组产前出血、急诊剖宫产、PPH发生率均明显低于CL缩短组,差异有统计学意义(P<0.05)。15例PPH患者中,严重PPH 6例,非严重PPH 9例。严重PPH患者孕中期及孕晚期胎盘下缘厚度均厚于非严重PPH患者,孕中期及孕晚期CL均短于非严重PPH患者,孕中、晚期胎盘下缘厚度差值与CL缩短差值均大于非严重PPH患者,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,孕中、晚期CL缩短差值预测严重PPH的AUC为0.90,最佳界限值为5.8 mm;孕中、晚期胎盘下缘厚度差值预测严重PPH的AUC为0.87,最佳界限值为4.5 mm;均具有一定预测价值。结论孕中、晚期CL缩短差值≥5.8 mm或胎盘下缘厚度差值≥4.5 mm,均可能导致严重PPH,及时判断PPH能为临床准备与管理、决定是否提前准备血源及选择适宜的剖宫产手术时机,降低母儿并发症风险提供有效的参考依据。

经阴道超声评估宫颈成熟度对临产时间的预测价值研究

目的探讨经阴道超声评估宫颈成熟度对临产时间的预测价值。方法选取2020年9月至2021年11月在河北省秦皇岛市第一医院建档并分娩的孕妇46例,根据距离临产时间(time to onset of labor,TOL)分为TOL≤2周组15例、TOL>2周组31例,分别记录孕妇的一般资料、宫颈Bishop评分,经阴道超声宫颈内外口前后唇的弹性值、宫颈长度、宫颈宽度、胎头距会阴的距离。采用多因素logistic回归分析临产时间的影响因素,采用受试者工作特征曲线分析宫颈长度、宫颈内口前唇弹性值对临产时间的预测价值。结果两组孕妇年龄、孕周、宫颈Bishop评分、宫颈宽度、胎头距会阴的距离、宫颈内口后唇弹性值、宫颈外口前唇弹性值、宫颈外口后唇弹性值比较差异均无显著性(P>0.05)。TOL≤2周组宫颈长度、宫颈内口前唇弹性值显著低于TOL>2周组,差异有显著性(P<0.05)。多因素logistic回归分析结果显示,宫颈内口前唇弹性值及宫颈长度是临产时间的独立影响因素(P<0.05)。受试者工作特征曲线分析显示,宫颈长度、宫颈内口前唇弹性值预测2周内临产的最佳截断值分别为2.95cm、7.95kPa,宫颈长度、宫颈内口前唇弹性值以及两者联合预测临产时间的曲线下面积分别为0.717、0.792、0.869,敏感度分别为54.8%、67.7%、71.0%,特异度分别为80.0%、86.7%、93.3%。结论宫颈内口前唇弹性值可作为临产时间的预测指标,且与宫颈长度联合可提高预测临产时间的准确性,为产科医生提供指导。