بررسی ارتباط بین اندازه‌گیری سونوگرافیک طول سرویکس در هفته 37 بارداری و پیامد زایمان به روش واژینال یا سزارین

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

2 دانش آموخته دستیاری زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

3 استاد گروه پزشکی اجتماعی، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

4 استاد گروه زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

5 دانشیار گروه مشاوره در مامایی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، پژوهشکده پیشگیری از بیماری‌های غیرواگیر، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

10.22038/ijogi.2025.85597.6338

چکیده

مقدمه: انجام سزارین پیش‌بینی نشده (اورژانسی) در طی فرآیند زایمان طبیعی ممکن است عوارض مادری و جنینی بیشتری به همراه داشته باشد. مطالعه حاضر با هدف بررسی نقش پیش‌بینی کننده طول سرویکس بر اساس سنجش سونوگرافیک در هفته 37 بارداری در روش زایمان به‌صورت واژینال یا سزارین انجام شد.
روش‌کار: این مطالعه ارزش تشخیصی در فاصله خرداد تا اسفند 140۱ بر روی 248 زن باردار مراجعه کننده به بیمارستان کوثر قزوین انجام گرفت. اندازه‌گیری سونوگرافیک طول سرویکس در هفته 37 بارداری به‌صورت ترانس واژینال انجام شد و پس از آن نوع زایمان به‌صورت طبیعی یا سزارین ثبت شد. تجزیه و تحلیل داده­ ها با استفاده از نرم‌افزار آماری SPSS (نسخه 27) و آزمون­ های تی مستقل، کای اسکوئر و تحلیل منحنی راک انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته ­ها: میانگین طول سرویکس در هفته 37 بارداری در زنانی که تحت سزارین قرار گرفتند، به‌طور معناداری بیشتر از زنانی بود که زایمان واژینال انجام دادند (11/24 در مقابل 02/22 میلی‌متر). در نقطه برش 5/21 میلی‌متر، حساسیت، ویژگی، ارزش اخباری مثبت و منفی و دقت کلی طول سرویکس در تشخیص سزارین به‌ترتیب برابر با 75%، 9/48%، 5/37%، 7/82% و 45/56% بود. فراوانی سزارین در افرادی که طول سرویکس بیشتر از 5/21 میلی‌متر داشتند، به‌طور معناداری بیشتر از زنانی بود که طول سرویکس کمتر از 5/21 میلی‌متر داشتند (5/37% در مقابل 3/17%) و داشتن طول سرویکس در هفته 37 بیشتر از 5/21 میلی‌متر با نسبت شانس 86/2، احتمال سزارین را افزایش می‌داد.
نتیجه­ گیری: طول سرویکس در هفته 37 بارداری می‌تواند به‌عنوان فاکتوری جهت پیش‌بینی وقوع زایمان به‌صورت سزارین استفاده شود، اما این فاکتور دارای قدرت تشخیصی پایین (از لحاظ ویژگی) است و باید در کنار سایر روش ­های تشخیصی مورد استفاده قرار گیرد.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Relationship between Sonographic Measurement of Cervical Length at 37 Weeks of Gestation and Outcome of Vaginal or Cesarean Delivery

نویسندگان [English]

  • Shokouh Abotorabi 1
  • Nafiseh Malek Motiei 2
  • Navid Mohammadi 3
  • Fatemeh Laloha 4
  • Zeinab Alimoradi 5
1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
2 Graduate of Obstetrics and Gynecology Residency, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
3 Professor, Department of Community Medicine, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
4 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
5 Associate Professor, Department of Midwifery Consultation, Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
چکیده [English]

Introduction: Unplanned (emergency) cesarean section during the natural delivery process may result in increased maternal and fetal complications. The present study was conducted with aim to investigate the predictive role of cervical length based on sonographic measurement at 37 weeks of pregnancy in vaginal or cesarean delivery.
Methods: This dignostic assessment study was conducted on 248 pregnant women referred to kowsar hospital, Qazvin between June 2022 and March 2023. Transvaginal ultrasound measurement of cervical length was performed at 37 weeks of pregnancy, and then the type of delivery was recorded as vaginal or cesarean. Data were analyzed by SPSS software (version 27) and Chi-square and Independent t-tests and ROC curve. P<0.05 was considered significant.
Results: The mean cervical length at 37 weeks of pregnancy in women who underwent cesarean section was significantly greater than in women who delivered vaginally (24.11 vs. 22.02 mm). At the cutoff point of 21.5 mm, sensitivity, specificity, positive and negative predictive values, and overall accuracy of cervical length in diagnosing cesarean section were 75%, 48.9%, 37.5%, 82.7%, and 56.45%, respectively. The frequency of cesarean section was significantly higher in women with a cervical length greater than 21.5 mm than in women with a cervical length less than 21.5 mm (37.5% vs. 17.3%), and having a cervical length greater than 21.5 mm at 37 weeks increased the likelihood of cesarean section with an odds ratio of 2.86.
Conclusion: Cervical length at 37 weeks of pregnancy can be used as a factor to predict cesarean section, but this factor has low diagnostic power (in terms of specificity) and should be used in conjunction with other diagnostic methods.

کلیدواژه‌ها [English]

  • Cesarean Section
  • Cervical Length
  • Sonographic Measurement
  • Vaginal Delivery

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مجله زنان، مامایی و نازایی ایران
دوره 28، شماره 10
دی 1404
صفحه 11-23

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