羊水指数联合宫颈长度预测双胎妊娠孕妇胎膜早破的效能分析

Efficacy analysis of amniotic fluid index combined with cervical length in predicting premature rupture of membranes in twin pregnant women

摘要:

目的 探讨超声测量羊水指数和宫颈长度对双胎妊娠孕妇胎膜早破的预测作用。方法 回顾性分析2016年1月—2019年7月在东南大学附属江阴医院孕检的112例双胎妊娠高危胎膜早破孕妇的资料（高危组），另回顾性分析96例同期在该院孕检的健康双胎妊娠孕妇的资料（健康组）。比较两组的绒毛膜性和羊膜性；比较两组的羊水指数和宫颈长度；比较高危组孕妇胎膜早破发生和未发生者的羊水指数和宫颈长度；分析羊水指数和宫颈长度预测双胎妊娠高危孕妇胎膜早破的效能。结果 两组并发症发生率比较，差异无统计学意义（P >0.05）；高危组各羊膜囊内羊水的最大垂直深度均高于健康组（P <0.05）；高危组的羊水指数高于健康组（P <0.05），宫颈长度短于健康组（P <0.05）；高危组胎膜早破发生率高于健康组（P <0.05）；高危组胎膜早破发生者羊水指数高于未发生者（P <0.05），宫颈长度短于未发生者（P <0.05）；羊水指数和宫颈长度的最佳截断值分别为31.42 cm和1.97 cm，羊水指数联合宫颈长度的敏感性、特异性和曲线下面积（AUC）均最高，分别为80.95%（95% CI：0.746，0.859）、85.71%（95% CI：0.768，0.917）和0.839（95% CI：0.751，0.896）。结论 双胎妊娠高危胎膜早破孕妇的羊水指数高于未发生者，而宫颈长度短于未发生者。超声测量羊水指数和宫颈长度可以预测双胎妊娠高危孕妇胎膜早破发生的风险，且超声测量羊水指数和宫颈长度预测双胎妊娠高危孕妇胎膜早破的效能较为理想。

关键词:超声检查;羊水指数;宫颈长度;双胎妊娠;胎膜早破

Abstract:

Objective To explore the predictive effect of ultrasound measurement of amniotic fluid index (AFI) combined with cervical length (CL) on premature rupture of membranes in twin pregnant women.Methods The data of 112 pregnant women with high risk of premature rupture of membranes who came to the hospital for pregnancy test from January 2016 to July 2019 were retrospectively analyzed, recorded as the high-risk group, and retrospective analysis the data of 96 healthy twin-gestational pregnant women in the same period of pregnancy test, recorded as the healthy group. The chorionic and amniotic types were compared between the two groups; the AFI and CL measured by ultrasound were compared between the high-risk group and the healthy group; the AFI and CL measured by ultrasound in pregnant women with premature rupture of membranes and those without premature rupture of membranes were compared; the efficacy of ultrasound measurement of AFI and CL in predicting premature rupture of membranes in high-risk pregnant women with twin pregnancy were analyzed.Results There were no significant difference in the incidence of complications between the two groups (P > 0.05), and the maximum vertical depth of amniotic fluid in each amnion sac in the high-risk group was higher than that in the healthy group (P < 0.05). Ultrasound measurement of AFI were higher and CL were lower in the high-risk group than those in the healthy group (P < 0.05). The incidence of premature rupture of membranes of pregnant women in the high-risk group was 18.75%, the incidence of premature rupture of membranes was higher than that of healthy group (P < 0.05), AFI in ultrasound measurement of the incidence were higher than that in non-occurrence in the high-risk group (P < 0.05), and CL were lower than that in non-occurrence (P < 0.05). The optimal cutoff points for AFI and CL were 31.42 cm and 1.97 cm, AFI combined with CL had the highest sensitivity, specificity, and area under the curve (AUC), which were 80.95% (95% CI: 0.746, 0.859), 85.71% (95% CI: 0.768, 0.917) and 0.839 (95% CI: 0.751, 0.896), respectively.Conclusion The AFI of high-risk premature rupture of membranes in twin pregnancy is higher than that in non-occurrence, and the CL is lower than that in non-occurrence. Ultrasound measurement of AFI and CL can predict the risk of premature rupture of membranes in high-risk pregnant women with twin pregnancy, and the effectiveness of ultrasound measurement for AFI and CL in predicting premature rupture of membranes in high-risk pregnant women with twin pregnancy is satisfactory.

Key words:ultrasound examination;amniotic fluid index;cervical length;pregnancy, twin;fetal membranes, premature rupture