Revista Chilena de Obstetricia y Ginecología (Jan 2008)
LONGITUD DEL CANAL CERVICAL UTERINO COMO FACTOR DE RIESGO DE PARTO PREMATURO EN PACIENTES SINTOMÁTICAS
Abstract
Objetivo: Determinar si el acortamiento del cuello uterino en pacientes sintomáticas es predictor de parto prematuro en o antes de las 35 semanas y dentro de 7 días. Método: Se estudiaron 852 pacientes que consultaron por dinámica uterina, a las que se midió el cuello uterino al ingreso. Las pacientes fueron manejadas de acuerdo a las Guías Clínicas del Hospital. Se excluyeron las pacientes en trabajo de parto, con membranas rotas o con cerclaje. Resultados: La edad gestacional promedio al ingreso fue 31,5 semanas (rango: 24,0-34,9). Se presentó parto prematuro a las 35 semanas o antes en 61 casos (7,2%), y dentro de los 7 días del ingreso en 14 pacientes (1,6%). Fueron predictores independientes significativos (OR; IC95%) para un parto Objective: To determine if the shortening of cervical length (CL) in women with threatened preterm labor could predict delivery at or before 35 weeks' gestation and within 7 days of presentation. Method: Sonogra-phic measurement of CL was done in 852 women with singleton pregnancies presenting with painful uterine contractions. Women in labor, with ruptured membranes or those with cervical cerclage were excluded. Re-sults: Median gestational age at presentation was 31.5 (range: 24.0-34.9) weeks and median cervical length was 31.5 (range: 3-61) mm. Delivery within 7 days occurred in 14 (1.6%) and delivery at or before 35 weeks, in 61 (7.2%) cases. Significant (OR; 95%CI) independent predictors of delivery at or before 35 weeks were vaginal bleeding (6.87; 2.83-16.65), cervical length (3.31; Cl 1.92-5.70) and a historyof preterm birth (2.03; 1.06-3.89). ROC curve analysis showed that a cervical length shorter than 19.5 mm (p<0.05) was the best cutoff valué for predicting a delivery at or before 35 weeks' gestation and within 7 days of presentation. Con-clusions: Shortening of cervical length in threatened preterm labor, especially when shorter than 19.5 mm, is associated with a significant risk of preterm labor <35 weeks' gestation and within 7 days of admission. Sonographic measurement of cervical length helps to recognize patients at risk for preterm birth, in order to focus interventions in that group of patients.
