宫颈超声检测预测自发性早产的临床价值

李琴1，丛林2，袁静2，方慧琴2

(1.皖南医学院附属弋矶山医院妇产科,安徽芜湖241001；2.安徽医科大学第一附属医院妇产科,安徽合肥230032)

【摘要】目的：探讨超声检测宫颈预测自发性早产较合适的检查孕周、检查方式及检查指标。方法：对在我院产检的具有早产高危因素的孕妇97例，分别在孕14～20+6周、孕21～27+6周、孕28～34+6周经阴道和经腹超声检测宫颈长度、宫颈管宽度及宫颈内口有无漏斗形成，随访妊娠结局。结果：①早产组与足月产组在宫颈管宽度、宫颈内口漏斗形成率上无统计学差异；②在孕14～20+6周测量的宫颈长度预测早产的ROC曲线下面积最大,以34.9 mm为界值时预测早产的敏感性为92.9%，特异性为92.5%；③经腹部超声与经阴道超声检测的宫颈长度、宽度无统计学差异(P>0.05)。结论：对具有早产高危因素的孕妇可从孕14～20+6周开始进行超声检测宫颈预测早产，可单用宫颈长度这一指标，以34.9 mm作为预测界值，经腹部超声和经阴道超声检查宫颈无明显差异。

【关键词】早产；预测；宫颈长度；超声

【文献标识码】【中图号】R 714.2A

DOI【】10.3969/j.issn.1002-0217.2015.02.012

文章编号：1002-0217(2015)02-0147-04

收稿日期：2014-09-15

作者简介：章瑄(1989-)，男，2012级硕士研究生，(电话)15955325456，(电子信箱)503424210@qq.com;

Clinical value of cervical sonography to predict spontaneous preterm deliveryLIQin,CONGLin，YUANJing,FANGHuiqin

Department of Gynecology and Obstetrics,Yijishan Hospital,Wannan Medical College,Wuhu 241001,China

Abstract【】Objective：To define the appropriate timing,detection modality and parameters measured for cervical sonogrpahy in predicting spontaneous preterm delivery.Methods: Ninety-seven women with high-risk gestation underwent ultrasound cervical assessment at gestational week between 14 and at <21,21 and at <28,28 and at <35 by either transabdorminal or transvaginal measurement of the longitudinal parameters and width of the cervix as well as presence or absence of cervical funneling.The pregnancy outcomes were also observed.Results: ①There was no difference of cervical width and the rate of cervical funneling between the preterm delivery group and the control group;② Receiver operating characteristic(ROC) curve analysis showed that (area under the curve,AUC)1 was significantly larger than AUC2 and AUC3 and cervical length of 34.9 mm was optimal cutoff that had sensitivities of 92.9% and specificity of 92.5%;③ No difference was found cervical length and width by either transabdorminal or transvaginal measurement(P>0.05).Conclusion: Cervical sonographical assessment of the preterm birth for high-risk gestations may start at between 14 and at <21 gestational week,and the assessment may rely on single cervical length and cutoff of 34.9 mm.However,there is no difference between the cervical parameters measured by transvaginal or transabdominal utrasound.

【Key words】 preterm delivery;prediction;cervical length;utrasound

早产在我国指的是妊娠28周至不足37周间的分娩,是绝大多数新生儿死亡和近半数先天性残疾的主要原因。因此预测早产以便及时干预早产是降低围生儿病死率和发病率的关键。宫颈形态的检测被广泛应用于临床来预测早产，目前国内外有关检测宫颈形态预测早产的研究很多,其预测价值通过系统评价也得到肯定[1],但在检查的孕周，检查的方式及检查指标的选择上无统一的标准。本……