| Objective:The relationship between cervical elasticity and spontaneous preterm birth was analyzed by cervical elastography in pregnant women,and a more reliable,objective and easy method for predicting preterm birth was discussed.Methods:According to the design of a prospective cohort study,pregnant women who meet the inclusion criteria were selected as the study subjects from January 2019 to December 2019 and were scheduled to give birth at the obstetrics clinic of the second affiliated hospital of kunming medical university and planned to give birth at our hospital.Mid pregnancy(21 weeks-23 weeks gestation+6 days)in our hospital maternity clinics regular prenatal routine ultrasound examination and pregnant women voluntarily signed the informed consent,the application of GE volusion E10 equipment,pregnant women in these 21 weeks-23 weeks gestation+ 6 days,31 weeks-32 weeks+6 days prior to the cervix and cervical mouth lip central ultrasound elasticity imaging,recording the measured elastic parameters,and then pregnancy outcomes in pregnant women who followed a included in the standard,the analysis of the elasticity of pregnant women cervix and its relationship between spontaneous preterm birth.Results:1.During this clinical study,260 pregnant women aged 21 weeks to 23 weeks+6 days were routinely examined by ultrasound,and relevant data were obtained from these 260 pregnant women.258 pregnant women due to its own conditions meet eligibility criteria,and they agreed to participate in this clinical research,including the final five pregnant women have made as a result of pregnancy complications cannot be carried out a statistical analysis to them and eventually excluded,leading to the final of this study is to perform statistical analysis of 253 cases of pregnant women have,of which 24 finally happened spontaneous preterm delivery for pregnant women,is the research object of the preterm birth rate was 9.5%(24/253).2.1 In this research object<37 weeks of spontaneous preterm birth pregnancy 21 weeks-23 weeks+6 days of the cervix mouth of strain rate is 0.23,the median is the scope(0.16 0.26),and 37 weeks or made in full-term pregnancy 21 weeks-23 weeks+6 days of the cervix mouth median strain rate is 0.08,the range is(0.05 0.15),p<0.01,the difference is statistically significant;Lip before at the same time,this study found that the cervical central happen<37 weeks premature pregnancy 21 weeks-23 weeks+6 days of strain rate is 0.15,the median(0.12 0.17),is the scope of all the research object.in 37 weeks or made in full-term pregnancy 21 weeks-23 weeks+6 days before the cervix lip is in the center of the strain rate of the median is 0.13,the range is(0.08 0.18),p=0.078,there was no statistically significant difference;The ratio of strain rate(SR)between the cervical opening and the central anterior lip of the cervix at 21 weeks to 23 weeks+6 days of gestation was 1.53(range of 1.25-1.75)in the<37 weeks preterm delivery group,and 0.75(range of 0.56-0.96)in the<37 weeks term delivery group,p<0.01,indicating a statistically significant difference.2.2 In table 2,the cervical length of pregnant women in the group of<37 weeks of preterm labor was 34.29±3.86mm at 21-23 weeks+6 days of ultrasound examination,while the cervical length range was 41.28±5.88mm at 21-23 weeks+6 days at?37 weeks of full-term labor,p<0.01,and the difference was statistically significant.2.3 To the cervix mouth of the strain rate and cervix strain than a more intuitive comparison of SR,this study made the cervix mouth of the strain rate and cervix strain than SR ROC curves,the results of the cervix mouth strain rate area under the curve is 0.889,the cervix strain than the area under the curve of the SR is 0.913,namely the cervix strain ratio than the cervix area under the curve of the large area under the curve of the strain rate.2.4 The parameters of this study is to draw the joint(the cervix mouth of the strain rate in combination with the cervical length,cervix strain than SR joint cervical length)and cervical length of ROC curve,in order to find a way to predict premature highest efficiency,the results for the cervical length of the area under the curve(AUC is 0.830,the cervix mouth of the strain rate in combination with the cervical length of AUC is 0.944,the cervix strain than SR joint cervical length CL AUC 0.951,AUC area is the largest.2.5 Based on the ROC curve of each parameter,the sensitivity and specificity of each parameter in predicting preterm delivery at 21 weeks to 23 weeks+6 days were plotted in this study.The results showed that the sensitivity of strain rate and cervical length was 0.921 at the highest and 0.875 at the lowest.The sensitivity of cervical strain ratio SR combined with cervical length was the second highest(0.838).2.6.1 21 weeks-23 weeks gestation+6 days,the cervix mouth by ultrasonic evaluation of purple(hard)on behalf of the cervical tissue with 159 pregnant women,and blue(on behalf of the cervical tissue medium hardness)of pregnant women have 70 people,yellow(on behalf of the cervical tissue medium soft)have 7 and the cervix mouth to red(on behalf of the cervical tissue softer)of 17 people,in childbirth gestational age<37 weeks of 24 people,21 weeks-23 weeks gestation+6 days the cervix mouth red group of 14 people preterm delivery,the probability is 58.3%,the yellow group number for 6 people,the probability is 25%,while the blue group premature happened two people,The probability was 8.3%,and the purple group also had 2 premature births,the probability was 8.3%,p<0.01,the difference was statistically significant.2.6.2 21 weeks-23 weeks gestation+6 days,before the cervix lip is central ultrasonic evaluation for purple(hard)on behalf of the organization of 154 pregnant women,and blue(on behalf of the organization of medium hardness)of pregnant women 44 people,yellow(on behalf of the organization of medium soft)42 and red group(soft)have 13 people,in childbirth gestational age<37 weeks of 24 people,and one red group,premature probability is 4.2%,yellow group of three people,premature probability is 12.5%,the blue group of eight people,premature probability is 33.3%,purple group has 12 people,premature probability is 50%,p=0.208,The difference was not statistically significant.2.6.3 In this study,the sensitivity and specificity(NPV,PPV,LR+,LR-)of predicting preterm delivery were calculated at 21 weeks to 23 weeks of gestation and 6 days of gestation.The results were as follows:the sensitivity and specificity were 0.833 and 0.983 in the red group and the yellow group(warm color group),and 0.5 and 0.918 in the blue group and the purple group(cool color group).2.6.4 Can be seen in table 7,21 weeks-23 weeks gestation+6 days in each of the cervix mouth color group in 31 weeks-32 weeks+6 days cervix funnel of pregnant women and probability,the number of the number of red group in the cervical funnel),accounting for 64.7%of the total number in the yellow group is 10%,blue group was 4.4%,the purple group was 7.6%,which occurred in the red group cervix funnel has the highest probability.In table 8,there was no cervical funnel sign in the middle of the anterior cervical lip due to the red group and the yellow group.3.1 In this study,among all the pregnant women in the full-term labor group,24 pregnant women who matched the characteristics of all the study groups in our preterm labor group(n=24)(including previous obstetric history,population age,and gestational age examination)were set as the control group,and then the study population was analyzed.The characteristics of the study population are shown in table 9.In the case-control study group,we found that the age of the pregnant women in the preterm delivery group was 27.38±3.37 years,and that of the pregnant women in the control group was 27.14±3.56 years,p=0.817,and the difference was not statistically significant.In the ultrasound examination,we measured the cervical length at 21-23 weeks+6 days of gestation.As a result,the median cervical length in the premature group was 35mm,with a range of 31.25mm-37mm,and the median cervical length in the full-term group was 40.5mm,with a range of 32.75mm-48mm,p=0.015.The difference was statistically significant3.2 In this study,a box-and-whisk plot was drawn,which showed the distribution of cervical strain ratio SR in the preterm delivery group and the control group.The cervical strain ratio in the preterm delivery group ranged from 1.25 to 1.75,with a median of 1.53,and the cervical strain ratio in the control group ranged from 0.87 to 1.02,with a median of 0.955.3.3 For preterm birth group and the control group before the cervix mouth and lip color elastic image is analyzed,the result is:the preterm group,the cervix mouth red have 14 people,probability of 58.3%,yellow has 6 people,the probability of 25%,blue two people,a 8.3%chance,purple with 2 people,probability is 8.3%,namely red group the highest incidence of preterm birth,yellow,blue and green the same probability,p<0.001,the difference is meaningful.For the color analysis of the central anterior lip of the cervix,p=0.519,the difference was not statistically significant.Conclusion:1.Cervical elasticity assessment at 21-23 weeks of gestation+6 days of gestation identifies women with a higher risk of preterm birth in low-risk asymptomatic women.2.Cervical strain rate or cervical strain was more effective in predicting premature labor than cervical length alone,and cervical strain was the most effective in predicting premature labor than cervical length alone.3.21 weeks-23 weeks gestation+6 days the cervix mouth color grouping method can be used to identify low risk of pregnancy,women with preterm labor symptoms in women have a higher risk of premature,warm color group(yellow and red)than cool color group(blue and purple)prediction accuracy and high efficiency,premature pregnancy 21 weeks-23 weeks+6 days the cervix before the middle of the lip color grouping in the identification of low-risk,in patients with asymptomatic women have a higher risk of premature meaningless4.The color of internal cervical orifice was red(soft tissue)at 21-23 weeks and 6 days of gestation,and the probability of occurrence of internal cervical funnel at 32 weeks was increased. |
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