Gestational age at cervical length measurement and incidence of preterm birth
Gestational age at cervical length measurement and incidence of preterm birth
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DOI：
10.1097/01.aog.0000270112.05025.1d
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发表时间：
2007-08-01
影响因子：
7.2
通讯作者：
Baxter, Jason K.
中科院分区：
文献类型：
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作者：
Berghella, Vincenzo;Roman, Amanda;Baxter, Jason K.
目的：根据经阴道超声宫颈长度和测量宫颈长度的孕龄来估计自发性早产的风险。方法：1995 年 7 月至 2005 年 6 月期间，在一个机构中确定了自发性早产高风险且在第 12 周至第 32 周之间进行经阴道超声宫颈长度测量的女性。自发性早产高风险女性的纳入标准是先前的 14 至 35 周自发性早产、锥形活检、苗勒氏管异常或两次或多次扩张和清宫。多胎妊娠、环扎术、早产或胎儿异常的妇女被排除在外。使用 Logistic 回归来估计 35、32 和 28 周之前的自发性早产风险。结果：755 名妇女接受了 2,601 次经阴道超声测量宫颈长度。 35周、32周和28周前自发性早产的发生率分别为17.7%、10.6%和6.7%。宫颈长度每增加一毫米，35 周前自发性早产的风险就会降低约 6%（比值比 0.94，95% 置信区间，0.92-0.95，P=.001），测量宫颈长度的妊娠每增加一周，自发性早产风险就会降低约 5%（比值比 0.95，95% 置信区间 0.92-0.98，P=.004）。 32周和28周前的自发性早产也得到了类似的结果。结论：经阴道超声测量宫颈长度的孕龄显着影响自发性早产风险的计算。随着子宫颈长度的缩短和胎龄的降低，自发性早产的风险会增加。这些自发性早产风险对于不同孕周不同程度宫颈长度短的女性的咨询和管理具有重要意义。
Objective: To estimate the risk of spontaneous preterm birth based on transvaginal ultrasound cervical length and gestational age at which cervical length was measured.Methods: Women at high risk for spontaneous preterm birth and with transvaginal ultrasound cervical length measurements between weeks 12 and 32 were identified at one institution between July 1995 and June 2005. Inclusion criteria for women at high risk for spontaneous preterm birth were prior spontaneous preterm birth at 14 to 35 weeks, cone biopsy, mullerian anomaly, or two or more dilation and evacuations. Women with multiple gestations, cerclage, indicated preterm birth, or fetal anomalies were excluded. Logistic regression was used to estimate the spontaneous preterm birth risk before 35, 32, and 28 weeks.Results: Seven hundred five women received 2,601 transvaginal ultrasound measurements for cervical length. The incidences of spontaneous preterm birth before 35, 32, and 28 weeks were 17.7, 10.6, and 6.7%, respectively. The risk of spontaneous preterm birth before 35 weeks decreased by approximately 6% for each additional millimeter of cervical length (odds ratio 0.94, 95% confidence interval, 0.92-0.95, P=.001) and by approximately 5% for each additional week of pregnancy at which the cervical length was measured (odds ratio 0.95, 95% confidence interval 0.92-0.98, P=.004). Similar results were obtained for spontaneous preterm birth before 32 and 28 weeks.Conclusion: Gestational age at which transvaginal ultrasound cervical length is measured significantly affects the calculation of risk of spontaneous preterm birth. The spontaneous preterm birth risk increases as the length of the cervix declines and as the gestational age decreases. These spontaneous preterm birth risks are important for counseling and management for women with various degrees of short cervical length at different gestational ages.