Use of uterine electromyography in the prediction of preterm birth after transvaginal cervical cerclage.

IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY BMC Pregnancy and Childbirth Pub Date : 2024-10-30 DOI:10.1186/s12884-024-06779-3
Haitian Xie, Menglan Zhu, Kewen Deng, Jinling Yi, Liqiong Zhu, Jianping Tan, Xiaohui Ji, Phei Er Saw, Chunwei Cao, Nengyong Ouyang, Hui Chen
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Abstract

Background: Preterm birth (PTB), complications of which account for approximately 35% of deaths among neonates, remains a crucial issue. Cervical insufficiency (CI) is defined as the inability of the utrine cervix to retain a pregnancy, leading to PTB. Cervical cerclage is an efficient surgery for CI patients by preventing the cervix from being further mechanically shortened. Unfortunately, a certain number of patients who had cerclage still delivered prematurely, raising the urgent need to accurately assess the risk of PTB in patients with cerclage. Uterine electromyography (uEMG) is an emerging technology that characterizes uterine contractions by describing the actual evolution process of uterine activity and has been used to predict PTB in recent years.

Method: In this single-center retrospective case-control study, singleton pregnancy women who received cervical cerclage and uEMG assessment between January 2018 and January 2022 at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled.

Results: 32 PTBs were observed of the 69 women who underwent assessment. Based on multivariate logistic regression analysis, PTB after cerclage was significantly associated with previous PTB history or mid-trimester pregnancy loss (OR: 2.87, 95%CI: 1.49-5.54) and contraction frequency detected by uEMG (OR: 2.24, 95%CI: 1.44-3.49). The AUC of contraction frequency (0.766, P<0.001) was observed, and the optimal cut-off value suggested by Youden Index was 1.75 times per hour. Combined with previous preterm history and cervical length, the AUC of contraction frequency reached 0.858. After stratification by contraction frequency, the median duration was 11 weeks in the high frequency group (> 1.75 times per hour) and 15 weeks in the low frequency group (≤ 1.75 times per hour) (P<0.001).

Conclusions: The uEMG effectively predicts PTB after transvaginal cervical cerclage and provides a new method for clinicians to evaluate the pregnancy outcome of CI patients.

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使用子宫肌电图预测经阴道宫颈环扎术后的早产情况。
背景:早产(PTB)并发症约占新生儿死亡人数的 35%,这仍然是一个至关重要的问题。宫颈机能不全(CI)是指子宫颈无法保留妊娠,从而导致早产。宫颈环扎术是针对宫颈机能不全患者的一种有效手术,可防止宫颈进一步机械性缩短。遗憾的是,一定数量的宫颈环扎患者仍然会早产,这就迫切需要准确评估宫颈环扎患者发生 PTB 的风险。子宫肌电图(uEMG)是一种新兴的技术,它通过描述子宫活动的实际演变过程来描述子宫收缩的特征,近年来已被用于预测PTB:在这项单中心回顾性病例对照研究中,纳入了2018年1月至2022年1月期间在中山大学孙逸仙纪念医院接受宫颈环扎术和uEMG评估的单胎妊娠妇女:在接受评估的69名妇女中,观察到32例PTB。根据多变量逻辑回归分析,宫颈环扎术后PTB与既往PTB病史或中期妊娠流产(OR:2.87,95%CI:1.49-5.54)和uEMG检测到的宫缩频率(OR:2.24,95%CI:1.44-3.49)显著相关。收缩频率的 AUC(0.766,P 1.75 次/小时)和低频率组(≤ 1.75 次/小时)的 15 周(PConclusions:uEMG 可有效预测经阴道宫颈环扎术后的 PTB,为临床医生评估 CI 患者的妊娠结局提供了一种新方法。
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来源期刊
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth OBSTETRICS & GYNECOLOGY-
CiteScore
4.90
自引率
6.50%
发文量
845
审稿时长
3-8 weeks
期刊介绍: BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.
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