Bewertung quantitativer sonografischer Gewebetypisierung und Längenbestimmung der Cervix uteri als neuer Prädiktor für Cervixinsuffizienz und Frühgeburtlichkeit

Ziel dieser vorliegenden Studie war es, die Anwendbarkeit und Aussagekraft der sonographischen Grauwertanalyse zur Diagnose der Zervixinsuffizienz zu überprüfen und den cut-off-Wert der Graustufenanalyse zu ermitteln. Die Studie sollte zum einen klären, ob ein Zusammenhang zwischen einer Zervixverkü...

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Bibliographic Details
Main Author: Römer, Annette
Contributors: Schmidt, Stephan (Prof. Dr.) (Thesis advisor)
Format: Dissertation
Language:German
Published: Philipps-Universität Marburg 2006
Frauenheilkunde und Geburtshilfe
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Table of Contents: OBJECTIVE: This study was to evaluate the predictice value of the uterine cervix tissue with the use of quantitative ultrasound grey level analysis and cervical length for preterm delivery. STUDY DESIGN: Sixty-eight patients with preterm labor between 20 and 35 weeks of gestation were included. When two-dimensional transvaginal ultrasound measurement of cervical length was completed, a region of interest of constant size was defined in the midsection of the posterior wall, and the tissue-specific gray scale was determined. Preterm delivery of <37 weeks of gestation was sought. RESULTS: Twenty-eight patients (41.2%) were delivered preterm. The risk for preterm delivery was increased significantly in patients with cervical length of ≤2.5cm (odds ratio, 7.67; 95% CI, 2.4-24.45), with Bishop score of ≥4 (odds ratio, 3.44; 95% CI, 1.21-9.75), and with decreased mean gray scale value (odds ratio, 12.13; 95% CI, 3.69-39.88). Parity and uterine contractions were not significant as predictors for preterm delivery, although the risk for preterm delivery increased with higher parity (odds ratio, 1.8; 95% CI, 0.68-4.79). The risk for preterm delivery remained nearly the same by uterine contractions (odds ratio, 0.92; 95% CI, 0.28-3.01). A mean scale value of ≤6.54 had the best cutoff value for the prediction of preterm delivery. For preterm delivery, a mean gray value ≤6.54 had a sensitivity of 82.1%, a specificity of 72.5%, a positive predictive value of 67.6%, and a negative predictive value 85.3%. Multiple logistic regression analysis indicated that, even when other variables are considered simultaneously, the mean gray scale value is the single best predictor of preterm delivery. CONCLUSION: Quantitative ultrasound tissue characterization of the uterine cervix predicts preterm delivery and provides additional information in the prediction of potential premature delivery.