The Preterm Prediction Study: Recurrence risk of spontaneous preterm birth
The Preterm Prediction Study: Recurrence risk of spontaneous preterm birth
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DOI：
10.1016/s0002-9378(98)70544-7
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发表时间：
1998-05-01
影响因子：
9.8
通讯作者：
Roberts, JM
中科院分区：
文献类型：
--
作者：
Iams, JD;Goldenberg, RL;Roberts, JM
目的：我们试图通过使用产科史、胎儿纤维连接蛋白和超声检查宫颈长度来估计经产妇女自发性早产的风险。根据1282例经产妇女最近一次分娩时的孕龄，采用logistic回归模型估计孕35周前自发性早产的概率（妊娠18 - 26周、27 - 31周、32 - 36周和大于或等于37周时的既往早产）、胎儿纤连蛋白状态（阳性=大于或等于50 ng/dl）和按百分位数组列出的宫颈长度在妊娠22至24周时测量的直径（小于或等于10 th =小于或等于25 nm，10 th至50 th = 26至35 mm，> 50 th = >35 mm）。纤连蛋白和宫颈长度结果对临床护理设盲。结果：在有早产史的胎儿纤连蛋白阳性妇女中，估计早产复发风险为35 mm。有早产史的妇女中，早产风险增加，但不受最近一次早产分娩时胎龄的影响。结论：自发性早产的复发风险根据胎儿纤维连接蛋白和宫颈长度而变化很大。宫颈长度和胎儿纤维连接蛋白结果对早产复发风险有明显影响。与胎儿纤连蛋白阴性的妇女相比，胎儿纤连蛋白阳性的妇女预测复发风险增加2 - 4倍，并且随着胎儿纤连蛋白阳性和胎儿纤连蛋白阴性妇女宫颈长度的缩短而增加。这些数据可能有助于照顾有早产史的妇女，并设计研究，以防止复发性早产。
OBJECTIVE: We sought to estimate the risk of spontaneous preterm birth in parous women by use of obstetric history, fetal fibronectin, and sonographic cervical length.STUDY DESIGN: The probability of spontaneous preterm birth before 35 weeks' gestation was estimated from a logistic regression model with data from 1282 parous women analyzed according to gestational age at the most recent prior delivery (prior preterm birth at 18 to 26 weeks, 27 to 31 weeks, 32 to 36 weeks, and greater than or equal to 37 weeks' gestation), fetal fibronectin status (positive = greater than or equal to 50 ng/dl), and cervical length by percentile groups (less than or equal to 10th = less than or equal to 25 nm, 10th to 50th = 26 to 35 mm, and >50th = >35 mm) measured at 22 to 24 weeks' gestation. Fibronectin and cervical length results were blinded for clinical care.RESULTS: Among fetal fibronectin positive women with a prior preterm birth, the estimated recurrence risk of preterm birth 35 mm. The risk of preterm birth was increased among women with a history of preterm delivery but was not influenced by the gestational age at delivery of the most recent preterm birth.CONCLUSION: The recurrence risk of spontaneous preterm birth varies widely according to fetal fibronectin and cervical length. Cervical length and fetal fibronectin results had distinct and significant effects on the recurrence risk of preterm birth. Predicted recurrence risk is increased by twofold to fourfold in women with a positive compared with a negative fetal fibronectin, and it increases as cervical length shortens in both fetal fibronectin-positive and fetal fibronectin-negative women. These data may be useful to care for women with a history of preterm birth and to design studies to prevent recurrent premature delivery.