응급과 긴급 자궁경부 원형결찰술을 시행한 임신부에서 조기분만 예측 인자로서 수술 후 측정한 자궁경부 길이의 유용성
THE PREDICTIVE VALUE OF POSTOPERATIVE CERVICAL LENGTH AFTER EMERGENT AND URGENT CERVICAL CERCLAGE AS A PREDICTIVE FACTOR OF PRETERM DELIVERY
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초록
목적응급과 긴급 자궁경부 원형결찰술을 시행 받는 임신부에서 임신 30주 이전 조기분만을 예측할 수 있는 예측인자로서 수술 후 질식초음파를 이용하여 측정한 자궁경부 길이의 유용성을 알아보고자 하였다. 연구방법자궁경부가 개대 되고 양막이 질쪽으로 탈출되어 응급 자궁경부 원형결찰술을 시행한 51명과 초음파상 자궁경부 내구의 깔대기모양 변화와 더불어 자궁경부 길이가 25 mm 미만으로 짧아져 긴급 자궁경부 원형결찰술을 시행한 40명을 대상으로 후향적으로 연구하였다. Receiver-operating characteristic (ROC) curve 분석, Pearson’s partial correlation coefficient와 다중로지스틱회귀분석을 사용하여 통계학적으로 분석하였다. 결과입원당시 평균 임신 주수는 응급 자궁경부 원형결찰술을 시행한 군은 21.2 ± 2.3주 긴급 자궁경부 원형결찰술을 시행한 군은 21.8 ± 3.2주이었다. 수술 후 측정한 자궁경부 길이는 응급 자궁경부 원형결찰술군은 17.6 ± 8.6 mm, 긴급 원형결찰술 군은 21.8 ± 8.7 mm로 증가하였다. ROC curve 분석에서 응급 자궁경부 원형결찰술군은 자궁경부 길이를 16.5 mm로 기준할 때, 민감도 85%, 특이도 50%, 양성예측도 17%, 음성예측도 16%, 긴급 자궁경부 원형결찰술군은 수술 후 자궁경부의 길이를 23.2 mm로 기준할 때, 민감도 65%, 특이도 45%,양성예측도 17%, 음성예측도 8%이었다. 다중로지스틱회귀분석 결과, 수술 후 측정한 자궁경부 길이는 교란인자 보정 후 임신 30주 이전조기분만과 독립적인 상관관계가 없었다(응급 원형결찰술군 P = 0.65, 긴급 원형결찰술군 P = 0.77). 결론응급과 긴급 자궁경부 원형결찰술 후 질식초음파를 이용하여 측정한 자궁경부의 길이는 증가하였으나, 임신 30주 이전 조기분만을 예측할 수 있는 유용한 인자는 아니다.
Abstract
Objective The aim of this study is to evaluate the value of the ultrasonographic cervical length after emergent and urgent cervical cerclage to prediction of preterm delivery in patients with incompetence of cervix. Methods Fifty-one women who underwen t emergent cervical cerclage and forty women who underwent urgent cervical cerclage were studied respectively. Receiver-operating characteristic (ROC) curve analysis, Pearson’s partial correlation coeffi cient, and multiple logistic regression analysis were used for statistical analysis. Results The mean gestational age at admission was 21.2 ± 2.3 weeks in emergent cerclage group and 21.8 ± 3.2 weeks in urgent cerclage group. Postoperative mean cervical length was 17.6 ± 8.6 mm in emergent group and 21.8 ± 8.7 mm in urgent group. The diagnostic indices of postoperative cervical length (cut-off value 16.5 mm in emergent cerclage, 23.2 mm in urgency cerclage) by ROC curve were sensitivity of 65%, specifi city of 45%, positive predictive value of 17%, and negative predictive value of 8% in emergent cerclage group and in urgent cerclage group, sensitivity of 85%, specifi city of 50%, positive predictive value of 17%, and negative predictive value of 16%. Multiple logistic regression analysis indicated that postoperative cervical length was not an independent predictor of preterm delivery after adjustment of confounding factors in emergent group (P =0.65) in urgent groups (P =0.77). Conclusion In the both groups, the postoperative cervical length was longer than preoperative. However the postoperative cervical length is not a useful predictor of preterm delivery in patients with emergent and urgent cervical cerclage.
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