阴道超声测量子宫颈管长度对前置胎盘孕妇紧急提早剖宫产的预测价值  

Predictive value of cervical canal length measured by transvaginal ultrasound for emergency early cesarean section of pregnant women with placenta previa

作　　者：温华惠 谢艳华 何雪莲[1] 王雪 高岩[1] WEN Huahui;XIE Yanhua;HE Xuelian;WANG Xue;GAO Yan(Sichuan Maternal and Child Health Hospital,Chengdu 610041,China)

机构地区：[1]四川省妇幼保健院,四川成都610041

出　　处：《西部医学》2022年第9期1376-1380,共5页Medical Journal of West China

基　　金：四川省卫生计生委科研项目(2018SZ0267)。

摘　　要：目的探讨阴道超声测量子宫颈管长度对前置胎盘孕妇紧急提早剖宫产的预测价值。方法选取2019年3月~2020年8月我院产科分娩的前置胎盘孕妇128例为研究对象,根据孕妇剖宫产时间分为紧急提早剖宫产组78例和足月择期剖宫产组50例。所有孕妇均于妊娠晚期进行阴道超声检查,测量子宫颈管长度。比较两组孕妇的临床资料、子宫颈管长度,绘制ROC曲线分析子宫颈管长度对前置胎盘孕妇紧急提早剖宫产的预测价值。以logistic回归分析前置胎盘孕妇行紧急提早剖宫产的危险因素。比较两组孕妇的妊娠结局和新生儿结局。结果紧急提早剖宫产组孕妇中有既往流产史、完全性前置胎盘的比例大于足月择期剖宫产组(P<0.05)。紧急提早剖宫产组孕妇经阴道超声测量的子宫颈管长度小于足月择期剖宫产组(P<0.05)。ROC曲线分析阴道超声测量子宫颈管长度的最佳截断值为25 mm,当子宫颈管长度≤25 mm时,对前置胎盘孕妇紧急提早剖宫产的预测价值最高,灵敏度为85.90%,特异度为82.00%(AUC=0.920,95%CI=0.874~0.966)。完全性前置胎盘(OR=2.452)、子宫颈管长度≤25 mm(OR=3.789)是前置胎盘孕妇行紧急提早剖宫产的危险因素(P<0.05)。紧急提早剖宫产组与足月择期剖宫产组孕妇的产后出血率、输血量以及新生儿出生窒息的比例比较无统计学差异(P>0.05)。紧急提早剖宫产组的低出生体重儿的比例高于足月择期剖宫产组(P<0.05)。结论阴道超声测量子宫颈管长度对前置胎盘孕妇紧急提早剖宫产有重要的预测价值,有助于加强围产期管理,避免妊娠不良结局。Objective To investigate the predictive value of cervical canal length measured by transvaginal ultrasound for emergency early cesarean section of pregnant women with placenta previa.Methods 128 pregnant women with placenta previa who delivered in the hospital were selected as the research subjects between March 2019 and August 2020.According to the time of cesarean section,the pregnant women were divided into emergency early cesarean section group(78 cases)and term cesarean section group(50 cases).All pregnant women received transvaginal ultrasound examination in the third trimester of pregnancy to measure the cervical canal length.The clinical data and cervical canal length of the two groups were compared.The ROC curve was used to analyze the predictive value of cervical canal length for emergency early cesarean section of pregnant women with placenta previa.Logistic regression analysis was performed to screen the risk factors for emergency early cesarean section of pregnant women with placenta previa.The pregnancy outcomes and neonatal outcomes of the two groups were compared.Results The proportions of pregnant women with miscarriage history and complete placenta previa in the emergency early cesarean section group were higher than those in the term cesarean section group(P<0.05).The cervical canal length measured by transvaginal ultrasound of the emergency early cesarean section group was smaller than that of the term cesarean section group(P<0.05).ROC curve analysis found that the best cut-off value of the cervical canal length measured by vaginal ultrasound was 25 mm.When the cervical canal length was shorter than 25 mm,the predictive value in emergency early cesarean section of pregnant women with placenta previa was the highest,with sensitivity of 85.90%and specificity of 82.00%(AUC=0.920,95%CI=0.874-0.966).Complete placenta previa(OR=2.452)and cervical canal length≤25 mm(OR=3.789)were risk factors for emergency early cesarean section of pregnant women with placenta previa(P<0.05).There were no statisti

关 键 词：前置胎盘 阴道超声 子宫颈管长度 剖宫产 围产期 

分 类 号：R714.2[医药卫生—妇产科学]