The preterm prediction study: A clinical risk assessment system
The preterm prediction study: A clinical risk assessment system
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DOI：
10.1016/s0002-9378(96)70225-9
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发表时间：
1996-06-01
影响因子：
9.8
通讯作者：
Roberts, J
中科院分区：
文献类型：
--
作者：
Mercer, BM;Goldenberg, RL;Roberts, J
目的：我们的目的是开发一个风险评估系统，用于预测自发性早产的临床信息，在23至24周的妊娠，并确定这样一个system.Study设计的预测值：共2929名妇女进行了评估之间的23和24周的妊娠在10个中心。人口统计学因素，社会经济地位，家庭和工作环境，药物和酒精的使用，以及病史进行了评估。确定了当前妊娠中有关症状、培养和治疗的信息。进行了人体模拟和宫颈检查。单变量分析和多变量逻辑回归进行了随机选择，构成85%的研究人群。派生的风险评估系统适用于其余15%的人口，以评估其validity.RESULTS：共有10.4%的妇女早产儿。自发性早产的多变量模型与自发性早产高度相关（p < 0.0001）。低体重指数（< 19.8）和Bishop评分增加与未经产和经产妇女的自发性早产显著相关。黑人种族、不良的社会环境和怀孕期间的工作与未经产妇女的风险增加有关。在经产妇女中，先前的产科结局掩盖了社会经济风险因素，每次自发性早产的自发性早产几率增加两倍。目前的妊娠症状，包括阴道出血，2周内的症状性宫缩，急性或慢性肺部疾病与未经产和经产妇女的自发性早产密切相关。当该系统应用于其余人群时，被定义为自发性早产高风险（大于或等于20%风险）的妇女的自发性早产风险比预测为低风险的妇女高3.8倍（未经产妇女）和3.3倍（经产妇女）。然而，风险评估系统确定了少数自发早产的妇女。对于初产妇和经产妇，敏感性分别为24.2%和18.2%，阳性预测值分别为28.6%和33.3%。尽管有可能制定一个分级风险评估系统，其中包括与未经产和经产妇女自发性早产高度相关的因素，这样的系统不能识别大多数随后自发早产的妇女。该系统具有研究价值，可作为评估旨在识别风险亚群的新技术的基础。
OBJECTIVE: Our aims were to develop a risk assessment system for the prediction of spontaneous preterm delivery using clinical information available at 23 to 24 weeks' gestation and to determine the predictive value of such a system.STUDY DESIGN: A total of 2929 women were evaluated between 23 and 24 weeks' gestation at 10 centers. Demographic factors, socioeconomic status, home and work environment, drug and alcohol use, and medical history were evaluated. Information regarding symptoms, cultures, and treatments in the current pregnancy were ascertained. Anthropomorphic and cervical examinations were performed. Univariate analysis and multivariate logistic regression were performed in a random selection, constituting 85% of the study population. The derived risk assessment system was applied to the remaining 15% of the population to evaluate its validity.RESULTS: A total of 10.4% of women were delivered of preterm infants. The multivariate models for spontaneous preterm delivery were highly associated with spontaneous preterm delivery (p < 0.0001). A low body mass index ( < 19.8) and increasing Bishop scores were significantly associated with spontaneous preterm delivery in nulliparous and multiparous women. Black race, poor social environment, and work during pregnancy were associated with increased risk for nulliparous women. Prior obstetric outcome overshadowed socioeconomic risk factors in multiparous women with a twofold increase in the odds of spontaneous preterm delivery for each prior spontaneous preterm delivery. Current pregnancy symptoms, including vaginal bleeding, symptomatic contractions within 2 weeks, and acute or chronic lung disease were variably associated with spontaneous preterm delivery in nulliparous and multiparous women. When the system was applied to the remainder of the population, women defined to be at high risk for spontaneous preterm delivery ( greater than or equal to 20% risk) carried a 3.8-fold (nulliparous women) and 3.3-fold (multiparous women) higher risk of spontaneous preterm delivery than those predicted to be at low risk. However, the risk assessment system identified a minority of women who had spontaneous preterm deliveries. The sensitivities were 24.2% and 18.2% and positive predictive values were 28.6% and 33.3%, respectively, for nulliparous and multiparous women.CONCLUSIONS: Although it is possible to develop a graded risk assessment system that includes factors that are highly associated with spontaneous preterm delivery in nulliparous and multiparous women, such a system does not identify most women who subsequently have a spontaneous preterm delivery. This system has investigational value as the basis for evaluating new technologies designed to identify at-risk subpopulations.