Can the optimal cervical length for placing ultrasound-indicated cerclage be identified?
Can the optimal cervical length for placing ultrasound-indicated cerclage be identified?
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能否确定超声指示环扎术的最佳宫颈长度？
DOI：
10.1002/uog.15674
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
VaginalUltrasoundTrialConsortium
中科院分区：
文献类型：
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作者：
Szychowski,JM;Owen,J;Hankins,G;Iams,JD;Sheffield,JS;Perez-Delboy,A;Berghella,V;Wing,DA;Guzman,ER;VaginalUltrasoundTrialConsortium
目的评价超声示环扎术对既往自然早产(PTB)妇女宫颈长度(CL)的影响。用多因素Logistic回归分析评价环扎预防复发 35、 32和 24 周的效果。用Bootstrap回归方法估计CL截断值范围内的优势比(OR)和顺应性。自举OR的第2.5和97.5百分位数决定了顺位。结果在301名CL<； 为25 mm的妇女中，142人接受了超声指示的环扎术，159人没有放置环扎术。少数CL<； 10 mm病例仅限于 <； 10 mm和 <； 25 mm之间的CL界值。对于35 周的Ptb<； ，有环扎和CL<； 25 mm环扎的妇女的OR值显著低于没有环扎的妇女，并且疗效维持在较小的CL截止点。Ptb<； 32 周的结果与此类似。对于 24 周，结果有所不同， <； 10 mm和 <； 15 mm之间的CL截止点的OR值增加到1(无益)，具有较宽的顺式，这归因于 <； 24 周的出生数量较少。结论超声提示的环扎手术对既往自发性肺结核患者的疗效因CL切断点和感兴趣的PTB孕周而异。环扎手术显著降低了 35和 <； 32 周的风险，在 <； 10 mm和 <； 25 mm之间的CL分界点，以较短的CL减少最大，肯定了既往有自发性肺结核且CL较短的妇女是超声指示环扎术的合适人选。版权所有©2015 ISUOG。由John Wiley&Sons Ltd.出版。
ObjectiveTo assess a continuum of cervical length (CL) cut‐offs for the efficacy of ultrasound‐indicated cerclage in women with previous spontaneous preterm birth (PTB).MethodsThis was a planned secondary analysis of a multicenter randomized clinical trial of ultrasound‐indicated cerclage for the prevention of PTB in high‐risk women. The efficacy of cerclage for preventing recurrent PTB < 35, < 32 and < 24 weeks' gestation was assessed using multivariable logistic regression analysis. Odds ratios (ORs) and CIs were estimated for a range of CL cut‐offs using bootstrap regression. The 2.5thand 97.5thpercentiles of bootstrapped ORs determined the CIs. Results were illustrated using smoothed curves superimposed on estimated ORs by CL cut‐off.ResultsOf 301 women with a CL < 25 mm, 142 underwent ultrasound‐indicated cerclage and 159 did not have cerclage placement. The few cases with CL < 10 mm limited the evaluation to CL cut‐offs between < 10 mm and < 25 mm. For PTB < 35 weeks, ORs in women with a cerclage and CL < 25 mm were statistically significantly lower than in those without cerclage, and efficacy was maintained at smaller CL cut‐offs. Results were similar for PTB < 32 weeks. For PTB < 24 weeks, results differed, with ORs increasing toward unity (no benefit), with wide CIs, for CL cut‐offs between < 10 mm and < 15 mm, attributed to the small number of births < 24 weeks.ConclusionsThe efficacy of ultrasound‐indicated cerclage in women with previous spontaneous PTB varies by action point CL cut‐off and by PTB gestational age of interest. Cerclage significantly reduces the risk of PTB < 35 and < 32 weeks, at CL cut‐offs between < 10 mm and < 25 mm, with the greatest reduction at shorter CL, affirming that women with prior spontaneous PTB and a short CL are appropriate candidates for ultrasound‐indicated cerclage. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.