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...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.展开更多
目的本研究旨在评估宫颈机能不全(cervical insufficiency,CI)与自发性早产(spontaneous preterm birth,SPB)之间的关联,并探讨宫颈剪切波弹性成像(shear wave elasticity,SWE)、宫颈长度(cervical length,CL)和宫颈前角(anterior cervi...目的本研究旨在评估宫颈机能不全(cervical insufficiency,CI)与自发性早产(spontaneous preterm birth,SPB)之间的关联,并探讨宫颈剪切波弹性成像(shear wave elasticity,SWE)、宫颈长度(cervical length,CL)和宫颈前角(anterior cervical angle,ACA)在预测CI引起的SPB中的应用价值。方法本研究纳入了2023年6月至2024年1月期间在南通大学附属医院及江南大学附属妇产医院产前门诊就诊或住院治疗的786例孕妇,其中足月组723例孕妇,早产组63例孕妇。使用迈瑞Resona R9 Pro/Eagus R9s超声仪,配备剪切波弹性成像软件,进行宫颈SWEI、CL和ACA的测量。此外,按照受检孕周将孕妇分为19~23^(+6)周、24~27^(+6)周、28~33^(+6)周、34~36^(+6)周4组,评估孕周与超声参数的关系。结果早产组孕妇的CL平均为25.42 mm,显著低于足月组的29.71 mm(P<0.001)。ACA在早产组平均为121°,高于足月组的99°(P<0.001)。宫颈各部位的SWE值在早产组也显著低于足月组:外口前唇(AE)为6.47 k Pa对比9.91 k Pa(P<0.001)、内口前唇(AI)为10.98 k Pa对比18.62 k Pa(P<0.001)、内口后唇(PI)为11.32 k Pa对比21.09 k Pa(P<0.001)、外口后唇(PE)为8.16 k Pa对比13.24 k Pa(P<0.001)。CL与孕周存在显著的负相关(r=-0.278,P=0.001)。联合预测指标在预测早产方面显示出较高的准确性和特异性,曲线下面积(AUC)达到0.952,灵敏度和特异度分别为95%和86%。结论宫颈SWE、CL和ACA的联合使用可以显著提高对CI导致SPB的预测效能,可以为临床医生提供了一个更全面、准确的工具,以识别高危孕妇并及时采取干预措施,减少早产的发生,改善母婴预后。展开更多
近年来早产发生率呈上升趋势,而大多数在妊娠34周前分娩的孕妇既往没有早产史。由于子宫颈缩短与早产的发生相关,因此评估宫颈长度并针对性地采取预防措施可减少早产的发生。经阴道超声评估妊娠中期宫颈长度是临床上预测自发性早产的最...近年来早产发生率呈上升趋势,而大多数在妊娠34周前分娩的孕妇既往没有早产史。由于子宫颈缩短与早产的发生相关,因此评估宫颈长度并针对性地采取预防措施可减少早产的发生。经阴道超声评估妊娠中期宫颈长度是临床上预测自发性早产的最佳方法之一。2024年美国母胎医学会(Society for Maternal-Fetal Medicine,SMFM)发布了咨询系列第70号文件《无自然早产史女性短子宫颈的管理指南》,内容涵盖了宫颈长度的测量、短宫颈的定义及预防治疗措施,为没有早产史的短宫颈孕妇的诊断和治疗提供了指导。展开更多
<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Prematurity is a public health problem in Brazil, ...<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Method:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 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</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">mm) than deliveries after 37 weeks. No statistically related differences were found between preterm birth and first trimester cervix measurements. </span><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;">: 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 suggest</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> a possible new cut-off point that increases the sensitivity of transvaginal ultrasound as a method of preventing prematurity.</span></span></span>展开更多
文摘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.
文摘目的本研究旨在评估宫颈机能不全(cervical insufficiency,CI)与自发性早产(spontaneous preterm birth,SPB)之间的关联,并探讨宫颈剪切波弹性成像(shear wave elasticity,SWE)、宫颈长度(cervical length,CL)和宫颈前角(anterior cervical angle,ACA)在预测CI引起的SPB中的应用价值。方法本研究纳入了2023年6月至2024年1月期间在南通大学附属医院及江南大学附属妇产医院产前门诊就诊或住院治疗的786例孕妇,其中足月组723例孕妇,早产组63例孕妇。使用迈瑞Resona R9 Pro/Eagus R9s超声仪,配备剪切波弹性成像软件,进行宫颈SWEI、CL和ACA的测量。此外,按照受检孕周将孕妇分为19~23^(+6)周、24~27^(+6)周、28~33^(+6)周、34~36^(+6)周4组,评估孕周与超声参数的关系。结果早产组孕妇的CL平均为25.42 mm,显著低于足月组的29.71 mm(P<0.001)。ACA在早产组平均为121°,高于足月组的99°(P<0.001)。宫颈各部位的SWE值在早产组也显著低于足月组:外口前唇(AE)为6.47 k Pa对比9.91 k Pa(P<0.001)、内口前唇(AI)为10.98 k Pa对比18.62 k Pa(P<0.001)、内口后唇(PI)为11.32 k Pa对比21.09 k Pa(P<0.001)、外口后唇(PE)为8.16 k Pa对比13.24 k Pa(P<0.001)。CL与孕周存在显著的负相关(r=-0.278,P=0.001)。联合预测指标在预测早产方面显示出较高的准确性和特异性,曲线下面积(AUC)达到0.952,灵敏度和特异度分别为95%和86%。结论宫颈SWE、CL和ACA的联合使用可以显著提高对CI导致SPB的预测效能,可以为临床医生提供了一个更全面、准确的工具,以识别高危孕妇并及时采取干预措施,减少早产的发生,改善母婴预后。
文摘近年来早产发生率呈上升趋势,而大多数在妊娠34周前分娩的孕妇既往没有早产史。由于子宫颈缩短与早产的发生相关,因此评估宫颈长度并针对性地采取预防措施可减少早产的发生。经阴道超声评估妊娠中期宫颈长度是临床上预测自发性早产的最佳方法之一。2024年美国母胎医学会(Society for Maternal-Fetal Medicine,SMFM)发布了咨询系列第70号文件《无自然早产史女性短子宫颈的管理指南》,内容涵盖了宫颈长度的测量、短宫颈的定义及预防治疗措施,为没有早产史的短宫颈孕妇的诊断和治疗提供了指导。
文摘<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Method:</span></b><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 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</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">mm) than deliveries after 37 weeks. No statistically related differences were found between preterm birth and first trimester cervix measurements. </span><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;">: 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 suggest</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> a possible new cut-off point that increases the sensitivity of transvaginal ultrasound as a method of preventing prematurity.</span></span></span>
