权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Assessing the Risk of Spontaneous Premature Birth by Electrical Impedance Spectroscopy of the Cervix.

通过子宫颈电阻抗光谱评估自然早产的风险。

基本信息

批准号：
MR/J014788/1
负责人：
Dilly Anumba
金额：
$ 64.16万
依托单位：
University of Sheffield
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2012
资助国家：
英国
起止时间：
2012 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FJ014788%2F1
关键词：
Assessing Risk Spontaneous Premature Birth

项目摘要

The timing of birth is crucial to reproduction. About 6-13% of babies are born prematurely at annual costs to the NHS of £1 billion more than for term babies. The cost of care in the first year of life for the surviving premature baby is 10-fold higher than for the term baby. Preterm birth (PTB) also accounts for the majority of deaths of structurally normal babies. A quarter of babies born before 28 weeks suffer handicap, with socio-economic burdens on families, many parents often having to give up work to care for their child. Prevention of PTB is limited by lack of accurate prediction of risk. Our group has been exploring the technique of electrical impedance spectroscopy (EIS) for assessing cervical tissue composition by recording its electrical "resistivity" - cervical impedance - to the injection of a small electrical current. Our thinking is that if we can detect the changes which occur in the cervix several months before labour starts we can predict women who will go into premature labour.To test out this theory we recently conducted a small pilot study. In a small group of women at risk of premature birth (because they have had premature births before), we recently showed that EIS holds promise for accurately predicting premature delivery - women who delivered before 37 weeks, as well as those who delivered before 34 weeks, had lower cervical impedance between 20 and 28 weeks than those who did not. We now propose to confirm these preliminary findings by larger studies. Firstly, we will improve the measuring device for EIS by standardising its contact to the cervix and improving its hardware and software. We will then undertake a large experimental study measuring cervical impedance in two groups of pregnant women - 250 women with risk factors for preterm birth - at two time points during pregnancy (22 and 26 weeks). We will seek to confirm the use of EIS in clinical care will improve our ability to predict, prevent, and treat preterm labour and birth. We will compare EIS to current screening methods such as the fibronectin test and cervical ultrasound. We will also undertake some preliminary cost analysis of its introduction into clinical care and determine whether it may prove cost-effective compared to standard current care.It has been well recognised that spontaneous PTB is often associated with uterine infection and inflammation but the mechanism and pattern of this association is unclear. Using modern techniques of profiling bacteria in the vagina we will explore whether the bacterial pattern in vaginal discharge of women who deliver preterm differs significantly from that of women who deliver at term. By finding this out we may be able to market a diagnostic kit which detects the pattern most associated with subsequent PTB which, combined with cervical EIS measurement, may improve our prediction of PTB. Prompt and improved identification of PTB risk by our studies will enable better care. This is possible through the administration of drugs such as the hormone progesterone, or others within the family of pain relief medication, known to prolong pregnancy. It may also help us to identify the "weak" cervix, a condition that continues to defy accurate diagnosis, so that a stitch can be more appropriately inserted round the cervix of those that truly need this, and avoided in those that do not need this. For women with symptoms of preterm labour cervical EIS may well identify those who are more likely to progress to birth than others, so that treatments to prepare the baby's lungs for birth, delay the birth, or ensure that birth occurs in an appropriately staffed and equipped health care facility can be provided. Most preterm births occur in women with no risk factors. At present there is no accurate method of screening all women. We therefore propose to measure cervical EIS at 22 week in 250 low risk women also, to determine whether it can be used for routine screening of all pregnant women for risk of PTB.

出生的时间对繁殖至关重要。大约有6-13%的婴儿早产，NHS每年的成本比足月婴儿高出10亿英镑。早产儿存活后第一年的护理费用比足月儿高10倍。早产（PTB）也是结构正常婴儿死亡的主要原因。在28周之前出生的婴儿中，有四分之一患有残疾，给家庭带来社会经济负担，许多父母往往不得不放弃工作来照顾孩子。PTB的预防因缺乏准确的风险预测而受到限制。我们小组一直在探索电阻抗谱（EIS）技术，通过记录其电阻率（宫颈阻抗）来评估宫颈组织成分，以注入小电流。我们的想法是，如果我们能在分娩开始前几个月检测到子宫颈的变化，我们就能预测哪些妇女会早产。为了验证这一理论，我们最近进行了一项小型的试点研究。在一小群有早产风险的妇女中（因为他们以前有过早产），我们最近表明，EIS有望准确预测早产-在37周之前分娩的妇女，以及那些在34周之前分娩的妇女，在20至28周之间的宫颈阻抗低于那些没有的妇女。我们现在建议通过更大规模的研究来证实这些初步发现。首先，我们将通过标准化其与宫颈的接触并改进其硬件和软件来改进EIS的测量装置。然后，我们将进行一项大型实验研究，测量两组孕妇（250名具有早产风险因素的妇女）在怀孕期间的两个时间点（22周和26周）的宫颈阻抗。我们将寻求证实在临床护理中使用EIS将提高我们预测，预防和治疗早产和分娩的能力。我们将比较EIS与目前的筛查方法，如纤维连接蛋白试验和宫颈超声。我们还将进行一些初步的成本分析，其引入临床护理，并确定它是否可能证明成本效益相比，标准的当前care.It已被公认为自发性PTB往往与子宫感染和炎症，但这种关联的机制和模式尚不清楚。使用现代技术分析阴道中的细菌，我们将探讨早产妇女阴道分泌物中的细菌模式是否与足月分娩妇女有显著差异。通过发现这一点，我们可能能够销售一种诊断试剂盒，检测与随后的PTB最相关的模式，结合宫颈EIS测量，可能会提高我们对PTB的预测。通过我们的研究，及时和改进的PTB风险识别将使更好的护理成为可能。这是可能的，通过管理的药物，如激素孕酮，或其他家庭的止痛药物，已知延长怀孕。它还可以帮助我们识别“弱”宫颈，这种情况仍然无法准确诊断，因此可以更适当地在真正需要的人的宫颈周围插入一针，并避免在那些不需要的人身上。对于有早产症状的妇女，宫颈EIS可以很好地识别出那些比其他人更有可能进展到分娩的妇女，以便治疗婴儿的肺部为分娩做好准备，延迟分娩，或确保分娩发生在适当的人员配备和设备的卫生保健设施中。大多数早产发生在没有危险因素的妇女中。目前还没有一种对所有妇女进行筛查的准确方法。因此，我们建议在250名低风险妇女中测量22周时的宫颈EIS，以确定其是否可用于所有孕妇的PTB风险的常规筛查。