关键词： PPROM cervical length fetal surgery fibronectin test preterm birth spina bifida

来  源：   DOI：10.3390/jcm12010123

Abstract：
Background: A remaining risk of fetal spina bifida (fSB) repair is preterm delivery. This study assessed the value of preoperative cervical length (CL), CL dynamics (∆CL) and fetal fibronectin (fFN) tests to predict obstetric complications and length of stay (LOS) around fSB repair. Methods: 134 patients were included in this study. All patients had CL measurement and fFN testing before fSB repair. ∆CL within the first 14 days after intervention and until discharge after fSB repair were compared in groups (∆CL ≥ 10 mm/<10 mm; ≥20 mm/<20 mm). CL before surgery, ∆CL’s, and positive fFN tests were correlated to obstetric complications and LOS. Results: Mean CL before surgery was 41 ± 7 mm. Mean GA at birth was 35.4 ± 2.2 weeks. In the group of ∆CL ≥ 10 mm within the first 14 days after intervention, LOS was significantly longer (p = 0.02). ∆CL ≥ 10 mm until discharge after fSB was associated with a significantly higher rate of GA at birth <34 weeks (p = 0.03). The 3 positive fFN tests before fSB repair showed no correlation with GA at birth. Conclusion: Perioperative ∆CL influences LOS after fetal surgery. ∆CL ≥ 10 mm until discharge after fSB repair has a 3-times higher rate of preterm delivery before 34 weeks. Preoperative fFN testing showed no predictive value for preterm birth after fSB repair and was stopped.
摘要：
背景：胎儿脊柱裂（fSB）修复的剩余风险是早产。这项研究评估了术前宫颈长度（CL）的价值，CL动力学（ΔCL）和胎儿纤连蛋白（fFN）测试可预测fSB修复周围的产科并发症和住院时间（LOS）。
方法：134例患者纳入本研究。所有患者在fSB修复前进行CL测量和fFN测试。在干预后的前14天内和fSB修复后直到出院之前的CL进行比较（CL≥10mm/＆lt;10mm;≥20mm/＆lt;20mm）。术前CL,取决于CL\'s,fFN测试阳性与产科并发症和LOS相关。
结果：术前平均CL为41±7mm。出生时平均GA为35.4±2.2周。在干预后的前14天内，△CL≥10mm的组中，LOS显著延长(p=0.02)。在fSB后出院前CL≥10mm与出生时GA的发生率明显较高<34周相关(p=0.03)。fSB修复前的3个阳性fFN测试显示与出生时的GA无相关性。
结论：围手术期△CL影响胎儿手术后的LOS。在fSB修复后出院前，CL≥10mm，34周前早产率高出3倍。术前fFN检测显示fSB修复后对早产无预测价值，因此停止了。
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