Résumé
Objectif
La mesure échographique par voie endovaginale du col utérin (EEV) fait aujourd’hui partie du bilan de toute menace d’accouchement prématuré (MAP). La recherche de fibronectine foetale (fFN) au niveau cervical a été proposée pour en améliorer son dépistage.
Matériel et méthode
Pour toute MAP, ont été réalisé: un toucher vaginal, un enregistrement des contractions utérines (CU), une mesure de l’EEV. Si cette dernière était comprise entre 15 et 25 mm une recherche de fFN était ajoutée. Les cliniciens étaient informés des différents résultats.
Résultats
Cent quatre-vingt huit patientes admises aux urgences pour MAP entre 24 et 34 SA présentaient un dossier complet. Parmi les différents examens, une EEV < 15 mm présente respectivement pour le dépistage de la prématurité < 37 SA ou un accouchement dans les sept jours une sensibilité de 56 et 79 %, une spécificité de 70 et 66 % et une valeur prédictive négative (VPN) de 81 et 98 %. En prenant 25 mm comme valeur seuil et en recherchant la fFN pour l’intervalle 15–25 mm, on obtient respectivement une sensibilité de 68 et 86%, une spécificité de 61 et 56%et une VPN de 84 et 98%. Les rapports de vraisemblance positifs et négatifs sont, quel que soit le test diagnostique significatif retenu et quel que soit le critère de jugement utilisé, très modestes.
Conclusion
Pour dépister la prématurité, la valeur seuil classique de 25 mm pour la mesure du col utérin est peu performante. Celle de 15 mm est plus intéressante, mais présente une faible sensibilité. L’adjonction de la recherche de fNF lorsque l’EEVest comprise entre 15 et 25 mm améliore les performances du dépistage de la prématurité.
Abstract
Background
Today, transvaginal ultrasound measurement of cervical length (CL) is done in all women presenting with threatened spontaneous preterm labor (PTL). Rapid measurement of fetal fibronectin (fFN) in the cervicovaginal secretions is proposed for a better screening of the PTL.
Material and methods
All pregnant women with spontaneous PTL received care including: digital cervical examination, external tocodynamometry for the monitoring of uterine contractions and measurement of CL. If CL was between 15 and 25 mm, fFN testing was added. Clinicians used the results of the test to guide therapeutic decisions.
Results
Were included 188 patients with spontaneous PTL between 24 and 34 SA. For the screening of prematurity < 37 WG or delivery within seven days, a CL < 15 mm had respectively a sensitivity of 56 and 79%, a specificity of 70 and 66% and a negative predictive value (NPV) of 81 and 98%. The association of fFN testing for the women with a CL between 15 and 25 mm give similar performance (sensitivity between 68 and 86%, specificity between 61 and 56% and VPN between 84 and 98%). Positive and negative likehood ratios were low.
Conclusion
To predict PTL, a cervical length < 25 mm had low performances. A CL cutoff value of ≤ 15 mm did better, but had low sensitivity. The addition of fNF detection for the women with a CL between 15 and 25 mm had better performances for the screening of prematurity.
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Sénéclauze-Seguin, V., Fritz, G. & Langer, B. Intérêt de la fibronectine couplée à la mesure échographique du col utérin en cas de menace d’accouchement prématuré. Rev. med. perinat. 5, 43–48 (2013). https://doi.org/10.1007/s12611-012-0209-1
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DOI: https://doi.org/10.1007/s12611-012-0209-1