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

出生的时机对繁殖至关重要。大约6%-13%的婴儿是早产的，NHS每年的成本比足月婴儿多10亿GB。存活的早产儿在生命的第一年的护理费用是足月婴儿的10倍。早产(PTB)也是结构正常婴儿死亡的主要原因。在28周前出生的婴儿中，有四分之一患有残疾，家庭承受着社会经济负担，许多父母经常不得不放弃工作来照顾孩子。由于缺乏准确的风险预测，结核病的预防受到限制。我们小组一直在探索电阻抗频谱(EIS)技术，通过记录其在注入小电流时的电阻率(宫颈阻抗)来评估宫颈组织的成分。我们的想法是，如果我们能在分娩前几个月检测到宫颈的变化，我们就可以预测哪些女性会早产。为了验证这一理论，我们最近进行了一项小型的初步研究。在一小部分有早产风险的妇女(因为她们以前有过早产经历)中，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在34周之前分娩的妇女，在20到28周之间的宫颈阻抗低于没有早产的妇女。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，我们将改进EIS的测量设备，将其与宫颈的接触标准化，并改进其硬件和软件。然后，我们将在怀孕期间的两个时间点(22周和26周)进行一项大型实验研究，测量两组孕妇-250名有早产危险因素的妇女-的宫颈阻抗。我们将寻求确认在临床护理中使用EIS将提高我们预测、预防和治疗早产和分娩的能力。我们将把EIS与目前的筛查方法进行比较，如纤维连接蛋白测试和宫颈超声。我们亦会就其引入临床护理服务进行一些初步的成本分析，并决定与现时的标准护理服务比较，这是否合乎成本效益。众所周知，自发性肺结核经常与子宫感染和炎症有关，但这种关系的机制和模式并不清楚。使用现代的阴道细菌图谱技术，我们将探索早产妇女与足月分娩妇女阴道分泌物中的细菌模式是否有显着不同。通过发现这一点，我们可能能够销售一种诊断试剂盒，该试剂盒可以检测与后续肺结核最相关的模式，结合宫颈EIS测量，可能会改善我们对肺结核的预测。通过我们的研究及时和改进对肺结核风险的识别将使更好的护理成为可能。这是可能的，通过给药，如激素黄体酮，或家庭中的其他止痛药，已知的延长怀孕。它还可以帮助我们识别出宫颈薄弱的情况，这种情况仍然无法得到准确的诊断，这样真正需要缝针的人可以更合适地在宫颈周围缝针，而不需要缝针的人则可以避免缝针。对于有早产症状的妇女，宫颈EIS可以很好地识别那些比其他人更有可能进展到分娩的人，以便为婴儿的肺部做好分娩准备、推迟分娩或确保分娩在配备适当人员和设备的卫生保健机构中进行治疗。大多数早产发生在没有危险因素的妇女身上。目前还没有对所有妇女进行准确筛查的方法。因此，我们建议在妊娠22周时也测量250名低风险妇女的宫颈EIS，以确定它是否可以用于对所有孕妇进行结核病风险的常规筛查。

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.