Frequency of uterine contractions and the risk of spontaneous preterm delivery.
Frequency of uterine contractions and the risk of spontaneous preterm delivery.
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DOI：
10.1056/nejmoa002868
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发表时间：
2002-01-24
影响因子：
158.5
通讯作者：
McNellis, D
中科院分区：
文献类型：
--
作者：
Iams, JD;Newman, RB;McNellis, D
背景：在随机试验中，子宫收缩频率的测量对降低早产率没有帮助。尽管如此，门诊监测收缩继续在临床实践中使用。方法：我们评估子宫收缩频率作为35周前自然早产风险的预测因子。我们招募了22至24周的单胎妊娠妇女。从入组到分娩或妊娠37周，妇女在家中使用宫缩监测仪记录每周2天或更多天的宫缩频率，每天两次。结果：306例妇女共获得34,908小时的成功监测记录。虽然35周前分娩的妇女比35周或更晚分娩的妇女记录到更多的宫缩，但我们无法确定有效识别早产妇女的阈值频率。在下午4点至凌晨3点59分之间，最大每小时宫缩频率为4次或更多的敏感性和阳性预测值分别为9%和25%，在22至24周，28%和23%在27至28周。其他建议的筛查试验，如宫颈的数字和超声评估以及宫颈阴道分泌物中胎儿纤维连接蛋白的测定，也对早产具有低敏感性和阳性预测价值。结论：虽然早产的可能性随着子宫收缩频率的增加而增加，但子宫收缩频率的测量在临床上对预测早产没有用处。[J] .中华医学杂志2002；33(4):326 - 326。版权所有(C) 2001马萨诸塞州医学协会。
Background: The measurement of the frequency of uterine contractions has not been useful for reducing the rate of preterm delivery in randomized trials. Nonetheless, ambulatory monitoring of contractions continues to be used in clinical practice.Methods: We assessed the frequency of uterine contractions as a predictor of the risk of spontaneous preterm delivery before 35 weeks of gestation. We enrolled women with singleton pregnancies between 22 and 24 weeks of gestation. The women used a contraction monitor at home to record contraction frequency twice daily on 2 or more days per week from enrollment to delivery or 37 weeks of gestation.Results: We obtained 34,908 hours of successful monitoring recordings from 306 women. Although more contractions were recorded from women who delivered before 35 weeks than from women who delivered at 35 weeks or later, we could identify no threshold frequency that effectively identified women who delivered preterm infants. The sensitivity and positive predictive value of a maximal hourly frequency of contractions of four or more between 4 p.m. and 3:59 a.m. were 9 percent and 25 percent, respectively, at 22 to 24 weeks and 28 percent and 23 percent at 27 to 28 weeks. Other proposed screening tests, such as digital and ultrasound evaluations of the cervix and assays for fetal fibronectin in cervicovaginal secretions, also had low sensitivity and positive predictive value for preterm labor.Conclusions: Although the likelihood of preterm delivery increases with an increased frequency of uterine contractions, measurement of this frequency is not clinically useful for predicting preterm delivery. (N Engl J Med 2002;346:250-5.) Copyright (C) 2001 Massachusetts Medical Society.