Metode probira u dijagnostici prijevremenog poroda

Grgić, Ozren (2010) Metode probira u dijagnostici prijevremenog poroda. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Background: In a population of pregnant women with signs and simptoms of threathened preterm labor only 25% will deliver preterm. The majority of screening test are characterized with low positive predictive value that leads to unnecessary hospitalization and therapy. In a last few decades sonographic assessment of cervical length (CL) as well as measurement of vaginal pH has had high diagnostic accuracy regarding the prediction of PTD in a high risk population. Additional sonographic parameter is a low qualitative glandular cervical score (QGCS) which is an early sign of accelerated cervical maturation that could improve diagnostic accuracy regarding the prediction of PTD in a population of pregnant women with signs and symptoms of threatened preterm labor. Materials and methods: Totally, 167 pregnant women with signs and symptoms of threatened preterm labor between 22 and 34 week are enrolled in this prospective cohort study. At any participants we measured CL, QGCS as well as vaginal pH. The best cut off points for CL was length < 15 mm, and < 25 mm, for QCGS < 1, and for vaginal pH were > 4.8 and > 5.0. The primary outcome included the diagnostic accuracy of tests regarding the prediction of PTD < 37 and < 34 weeks. Results: The overall incidence of PTD < 37 weeks was 25.1 %(42/167) whereas the incidence of PTD < 34 weeks was 12.6 %(21/167).Shortened CL < 25 mm was found in 31.7% (53/167) whereas CL < 15 mm was found in 10.2% (17/167). Low QGCS was present in 26.9% (45/167) whereas high pH > 4.8 in 34.1% (57/167) and > 5.0 in 16.2% (27/167). The best diagnostic accuracy regarding the prediction of PTD < 37 and < 34 weeks had pH > 5.0 (< 37 weeks LR 5.7 95% CI [2.3-14.4]), and < 34 weeks LR 4.7 95% CI [1.6-13.3]. Only pH > 5.0 (LR 4.7 95% CI [1.6-13.3]) and CL < 15 mm (LR 2.4 95% CI [1.1-5.3]) had statistically significant accuracy regarding the prediction of PTD < 34 weeks. Conclusion: In a population of pregnant women with sighs and symptoms of preterm labor only vaginal pH > 5.0 and CL < 15 mm could predict PTD < 34 weeks.

Abstract in Croatian

Uvod: Kod trudnica sa znakovima prijetećeg prijevremenog poroda (PP) stvarna učestalost PP se kreće oko 25% . Velika većina dosadašnjih testava probira karakterizirani su niskom pozitivnom prediktivnom vrijednošću koja dovodi do velikog broja lažno pozitivnih nalaza te nepotrebne hospitalizacije i terapije. U zadnjih nekoliko desetaka godina ultrazvučno (UZV) mjerenje duljine cerviksa te mjerenje vaginalnog pH imaju visoku dijagnostičku točnost u procijeni PP u visokorizičnoj populaciji dok UZV mjerenje žljezdanog područja cerviksa predstavlja dodatno obilježje kojim možemo procijeniti ubrzano sazrijevanje cerviksa i na taj način pridonjeti boljem i točnijem procijeni rizika PP u populaciji trudnica sa znakovima prijetećeg PP. Ispitanice i metode: U prospektivnom kohortnim istraživanju uključili smo 167 trudnica sa znakovima prijetećeg PP između 22 i 34 tjedna trudnoće. Kod svake trudnice smo UZV mjerili duljinu cerviksa i kvalitativnu analizu žljezdanog područja te odredili vaginalni pH. Najoptimalnije točke prijeloma duljine cerviksa su bile duljina < 15 mm te < 25 mm, kvalitativni glandularni cerviklani zbroj < 1 te vaginalni pH >4.8 te >5.0. Cilj istraživanja je bio odrediti dijagnostičku točnost te omjer vjerojatnosti (LR) testova u svrhu predviđanja PP < 37 te < 34 tjedana. Rezultati: Ukupna učestalost PP < 37 tjedana je bila 25.1% (42/167), dok je učestalost PP < 34 tjedana bila 12.6% (21/167). Duljina cerviksa < 25 mm je opažena u 53/167 (31.7%), a duljina < 15 mm u 17/167 (10.2%) trudnica. Nizak kvalitativni žljezdani zbroj je bio pisutan u 45/167 (26.9%) dok je visoki pH > 4.8 bio prisutan u 57/167(34.1%), a > 5.0 u 27/167 (16.2%) trudnica. Mjere dijagnostičke točnosti predviđanja PP < 37 i < 34 tjedana su bile najbolje kod mjerenja pH > 5.0 (za < 37 tjedana LR 5.7 95% CI [2.3-14.4]), za < 34 tjedana LR 4.7 95% CI [1.6-13.3]. Statističku značajnost u svrhu predviđanja PP < 34 tjedana su imali samo pH > 5.0 (LR 4.7 95% CI [1.6-13.3]) i duljina cerviksa < 15 mm (LR 2.4 95% CI [1.1-5.3]. Zaključak: U populaciji trudnica sa simptomima prijetećeg PP jedino povišen pH > 5.0 i skraćenje duljine cerviksa < 15 mm mogu predvidjeti PP < 34 tjedana.

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