宫颈长度对前置胎盘分娩时机的预测  

Prediction of time of delivery by ultrasound-measured cervical length in pregnant women with placenta previa

作　　者：车荣华[1] 杨燕 

机构地区：[1]同济大学附属第一妇婴保健院产科,上海201204 [2]上海市闵行区中心医院妇产科,上海200233

出　　处：《现代妇产科进展》2015年第4期276-278,共3页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨子宫颈管长度的测量对前置胎盘提早剖宫产的预测价值。方法:回顾分析103例前置胎盘孕妇,根据孕晚期阴道超声测量子宫颈管长度将患者分为两组:观察组(宫颈长度≤25mm)及对照组(宫颈长度>25mm),比较两组的妊娠结局,并绘制子宫颈管长度预测前置胎盘孕36周前提早剖宫产的ROC曲线,计算曲线下面积和最佳临界点。结果:观察组患者产前出血时的孕周和分娩时孕周均明显短于对照组,差异均有统计学意义(P<0.05)。观察组孕妇的产前出血、早产、孕36周前的剖宫产发生率明显高于对照组,差异有统计学意义(P<0.001),新生儿出生体重及5min Apgar评分低于对照组,转儿科治疗率上明显高于对照组,差异均有统计学意义(P<0.001);两组的输血、新生儿窒息方面差异无统计学意义(P>0.05)。以宫颈长度25mm作为发生孕36周前提早剖宫产的预测值,其敏感度为83.6%,特异度为78.3%,ROC曲线下面积85.5%。根据ROC曲线分析得出预测提早剖宫产的宫颈长度最佳阈值为26.5mm。结论:阴道超声测量前置胎盘孕妇子宫颈管长度可作为预测其紧急提早剖宫产发生的一种方法,从而加强干预管理,避免严重的围产期并发症发生。Objective：To evaluate whether cervical length measurements can predict preterm cesarean delivery in pregnant women with placenta previa. Methods：103 women with placenta previa were retrospectively categorized into two groups based on cervical length,obser-vation group（short cervical length≤25mm）and control group（long cervical length 〉25mm）. Pregnancy outcomes between two groups were compared. Draw ROC curve of cervical length to predict cesarean section before 36 weeks with placenta previa, and calculate area under the curve and optimal critical point. Results：The gestational age of the observation group at the time of antepartum hemorrhage and delivery was significantly shorter than the control group,and the difference was statistically significant （ P〈0 . 05 ） . Two groups of pregnant women in antepar-tum bleeding,pretmature birth,the incidence of cesarean delivery before 36 weeks,the observa-tion group was significantly higher and the difference was statistically significant （ P〈0 . 001 ） . The birth weight and 5 ＆#39; Apgar score in the observation group were lower than that in control group,and the pediatric treatment was significantly higher,and the differences were statistically significant （P〈0. 001）. About blood transfusion and neonatal asphyxia,the difference was not statistically significant （ P〉0 . 05 ） . Using cervical length 25 mm to predict cesarean section be-fore 36 weeks of pregnancy,the sensitivity was 83. 6%,specificity was 78. 3%,the area under the ROC curve of it was 85 . 5%. The optimal threshold of cervical length was 26 . 5 mm to value preterm cesarean delivery according to ROC curve analysis. Conclusion：The transvaginal ultra-sound to measure cervical length in pregnant women with placenta previa can be used as a pre-dictive method for its emergency caesarean section occurred early,thereby strengthening inter-vention management,to avoid serious perinatal complications.

关 键 词：前置胎盘 子宫颈管长度 提早剖宫产 阴道超声 预测 

分 类 号：R714.2[医药卫生—妇产科学]