孕期宫颈长度在前置胎盘紧急剖宫产中的预测价值  

The clinical value of cervical length to predict emergency cesarean section during pregnancy in placenta previa woman

作　　者：李亚妮 肖景华 王艳霞 许欣 

机构地区：[1]西北妇女儿童医院妇产科,西安710061

出　　处：《现代妇产科进展》2018年第1期37-40,共4页Progress in Obstetrics and Gynecology

摘　　要：目的:评估孕期宫颈长度(CL)能否作为前置胎盘紧急剖宫产(CS)的一个预测指标。方法:回顾分析2010年1月至2014年11月于我院妇产科就诊的93例前置胎盘孕妇的临床资料,阴道多普勒超声测量患者不同妊娠期的CL,分别记为CL1(孕19~23周)、CL2(孕24~28周)、CL3(孕29~31周)和CL4(孕32~34周)。31例因阴道大出血行紧急CS,62例行择期CS。比较两组患者的临床资料、CL变化及临床结局,并分析前置胎盘患者发生紧急CS的危险因素及CL变化对紧急CS的预测价值。结果:两组的CL均随妊娠期进展而逐渐缩短,孕29~31周时两组的CL比较,差异无统计学意义;孕32周后紧急CS组的CL突然明显缩短,择期CS组仍持续缓慢缩短。多因素Logistic回归分析显示,入院时阴道出血(OR=34.710,95%CI为5.239~229.973)和CL变化(OR=3.522,95%CI为1.210~10.253)是紧急CS的危险因素。ROC曲线显示,CL变化可作为紧急CS的预测指标(AUC=0.74,P<0.05),最佳cut-off值为6.0mm。结论:入院时阴道出血和CL变化是前置胎盘紧急CS的独立预测因子,前置胎盘孕妇妊娠中期至晚期CL变化超过6mm有较高风险行紧急CS。妊娠中期或晚期单次的CL缩短并不能预测紧急CS。Objective： To assess whether the CL changes over time could be used as a predictor of emergency CS in placenta previa woman. Methods： 93 placenta previa were retrospectively analyzed in Obstetrics and Gynecology Department of our hospital from Jan. 2010 to Nov. 2014.Cervical length were measured through transvaginal ultrasound in different gestation,respectively divided into CL1（ 19 to 23 weeks of gestation）,CL2（ 24 to 28 weeks of gestation）,CL3（ 29 to 31 weeks of gestation） and CL4（ 32 to 34 weeks of gestation）.31 underwent emergency CS for vaginal hemorrhage,and 63 others underwent selective CS. The clinical data,CL changes and clinical outcomes of the two groups were compared.The risk factors and the predictive value of CL changes in emergency CS of placenta previa woman were analyzed.Results： CL tended to decrease with advancing gestational age in each group.Until 29 - 31 weeks,CL showed no significant differences between the two groups.After 32 weeks,CL in the emergency CS group decreased abruptly,while CL in the elective CS group continued to gradually decrease.On multivariate analysis to determine risk factors,only admissions for bleeding（ OR = 34.710,95% CI 5.239 - 229.973） and change in CL（ OR = 3.522,95%CI 1.210 - 10.253） were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS（ area under the curve 0.734,P〈0.001）,with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm.Conclusion： Admission vaginal bleeding and CL changes were independent predictors of emergency CS in placenta previa woman.The CL change more than 6 mm between second and third trimester shows high risk of emergency CS in placenta previa woman,while a single time shortening could not predict emergency CS.

关 键 词：宫颈长度 阴道超声 前置胎盘 紧急剖宫产 预测 

分 类 号：R714.46[医药卫生—妇产科学]