胎盘增生谱患者的宫颈长度及其与计划外分娩的关系。

IF 2.1 4区医学 Q2 ACOUSTICS

Journal of Ultrasound in Medicine Pub Date : 2025-05-21 DOI:10.1002/jum.16729

Elias Kassir, Edgar A Hernandez-Andrade, Farah H Amro, Cabrina I Becker, Eleazar E Soto-Torres, Ramesha Papanna, Han-Yang Chen, Sarah T Mehl, Lavanya H Palavalli Parsons, Sean C Blackwell, Baha M Sibai

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引用次数: 0

摘要

目的：评价宫颈长度（CL）与胎盘增生谱（PAS）患者非预定分娩的关系。方法：对2018年1月至2024年6月疑似PAS患者进行回顾性队列研究。疑似PAS患者每4周接受一系列超声检查，包括经阴道CL测量。分析了分娩前的最终CL测量值。计划外分娩被定义为由于出血或早产而在计划日期之前紧急分娩。建立受试者工作特征（ROC）曲线，选择与计划外分娩相关的最佳CL，并进行关联分析和预测分析。结果：102例患者中，21例（20.6%）为计划外分娩。计划外分娩时中位胎龄为30w5d (IQR 29w0 -34w1d)，计划外分娩时中位胎龄为34w0d （IQR 33w1d-34w4d, P = 0.001）。非计划分娩患者的CL较计划分娩患者短（平均[SD] 29.9 [10.2] mm对36.1 [10.3]mm, P = .02）。有分娩的患者（n = 53） CL较短（31.6 [SD 11.1] mm）。结论：在PAS患者中，CL≤30 mm与较高的计划外分娩率和分娩≤34周相关。

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Cervical Length in Patients With Placenta Accreta Spectrum and Its Association With Unscheduled Delivery.

Objectives: To evaluate the association between cervical length (CL) and unscheduled delivery in patients with placenta accreta spectrum (PAS).

Methods: Retrospective cohort study of patients with suspected PAS from January 2018 to June 2024. Patients with suspected PAS underwent serial ultrasounds including transvaginal CL measurement every 4 weeks. The final CL measurement prior to delivery was analyzed. Unscheduled delivery was defined as urgent delivery prior to the scheduled date due to either bleeding or preterm contractions. A receiver operating characteristics (ROC) curve was created, the optimal CL associated with unscheduled delivery was selected, and associations and prediction analyses were performed.

Results: Of 102 patients, 21 (20.6%) had an unscheduled delivery. Median gestational age at unscheduled delivery was 30w5d (IQR 29w0d-34w1d), and at scheduled delivery 34w0d (IQR 33w1d-34w4d, P = 0.001). CL was shorter in patients who had an unscheduled delivery compared to those with a scheduled delivery (mean [SD] 29.9 [10.2] mm versus 36.1 [10.3] mm, P = .02). CL was shorter (31.6 [SD 11.1] mm) among patients (n = 53) having a delivery <34w0d than those (n = 49) delivering ≥34.0w0d (38.5 [SD 8.6] mm, P < .001). ROC analysis showed a CL of 30 mm as the optimal cutoff for prediction of unscheduled delivery. A significant association between CL ≤30 mm with unscheduled delivery (adjusted relative risk [aRR] 2.33, 95% CI: 1.08-5.03, P = .03) was observed after adjusting for history of spontaneous preterm birth.

Conclusions: In patients with PAS, a CL ≤30 mm is associated with a higher rate of unscheduled delivery and delivery ≤34 weeks.

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来源期刊

Journal of Ultrasound in Medicine 医学-核医学

CiteScore

5.10

自引率

4.30%

发文量

205

审稿时长

1.5 months

期刊介绍： The Journal of Ultrasound in Medicine (JUM) is dedicated to the rapid, accurate publication of original articles dealing with all aspects of medical ultrasound, particularly its direct application to patient care but also relevant basic science, advances in instrumentation, and biological effects. The journal is an official publication of the American Institute of Ultrasound in Medicine and publishes articles in a variety of categories, including Original Research papers, Review Articles, Pictorial Essays, Technical Innovations, Case Series, Letters to the Editor, and more, from an international bevy of countries in a continual effort to showcase and promote advances in the ultrasound community. Represented through these efforts are a wide variety of disciplines of ultrasound, including, but not limited to: -Basic Science- Breast Ultrasound- Contrast-Enhanced Ultrasound- Dermatology- Echocardiography- Elastography- Emergency Medicine- Fetal Echocardiography- Gastrointestinal Ultrasound- General and Abdominal Ultrasound- Genitourinary Ultrasound- Gynecologic Ultrasound- Head and Neck Ultrasound- High Frequency Clinical and Preclinical Imaging- Interventional-Intraoperative Ultrasound- Musculoskeletal Ultrasound- Neurosonology- Obstetric Ultrasound- Ophthalmologic Ultrasound- Pediatric Ultrasound- Point-of-Care Ultrasound- Public Policy- Superficial Structures- Therapeutic Ultrasound- Ultrasound Education- Ultrasound in Global Health- Urologic Ultrasound- Vascular Ultrasound