经会阴超声测量参数对孕期经阴道宫颈环扎术治疗的高龄孕妇自发性早产风险的预测价值OA

Objective To explore the predictive value of perineal ultrasound measurement parameters for the risk of spontaneous preterm birth(sPTB)in elderly pregnant women treated with transvaginal cervical cerclage during pregnancy.Methods A retrospective study was conducted on 265 elderly pregnant women diagnosed with cervical insufficiency and treated with transvaginal cervical cerclage at the Sichuan Provincial Maternal and Child Health Hospital,from January 2022 to September 2024.According to the pregnancy outcome,the patients were divided into a preterm birth group(<37 weeks,n=84)and a full-term birth group(≥37 weeks,n=181).All patients underwent perineal ultrasound examination 48 hours before cervical cerclage,and the cervical length and the anterior uterocervical angle were measured and recorded.The differences in general data and ultrasound parameters between the two groups were compared.The predictive efficacy of cervical length and the anterior uterocervical angle,individually and in combination,for sPTB was assessed using the receiver operating characteristic(ROC)curve.Multivariate Logistic stepwise regression was used to analyze the independent influencing factors of sPTB.Results The cervical length in the preterm birth group was shorter than that in the full-term birth group,and the anterior uterocervical angle was larger than that in the full-term birth group(P<0.05).ROC curve analysis showed that the area under the curve for cervical length,the anterior uterocervical angle,and their combination in predicting the risk of sPTB in elderly pregnant women treated with transvaginal cervical cerclage during pregnancy were 0.834(95%CI:0.789-0.884),0.759(95%CI:0.714-0.804),and 0.902(95%CI:0.857-0.947),respectively.The proportions of patients with emergency cerclage,a history of induced abortion≥3 times,a history of preterm birth,reproductive tract infections,and smoking during pregnancy were significantly higher in the preterm birth group than in the full-term birth group(P<0.05).Multivariate Logistic stepwise regression analysis showed that emergency cerclage(OR=1.941,95%CI:1.119-3.366),history of preterm birth(OR=2.195,95%CI:1.184-4.069),reproductive tract infection(OR=2.230,95%CI:1.291-3.853),cervical length(OR=0.409,95%CI:0.278-0.600),and anterior uterocervical angle(OR=2.649,95%CI:1.786-3.927)were independent influencing factors for the risk of sPTB in these patients(P<0.05).Conclusion Cervical length and the anterior uterocervical angle measured by perineal ultrasound have good predictive value for the risk of spontaneous preterm birth in elderly pregnant women undergoing transvaginal cervical cerclage during pregnancy.The combination of these two parameters can provide a more valuable risk assessment.