Évaluation de l'utilité de la mesure échographique de la longueur du col utérin pour optimiser le moment de la corticothérapie anténatale en cas de travail prématuré

Abstract : Objective. Diagnosis of preterm labor is based on the ultrasound measurement of cervical length. Our study aims to evaluate the usefulness of this measure to optimize the timing of antenatal corticosteroids. Methods. We conducted a retrospective study between May 2013 and March 2017. Patients hospitalized for preterm labor between 24 and 34 weeks of gestation and whose cervical length was less than 25mm were included. The primary endpoint was the rate of delivery within 7 days from the first dose of corticosteroids. We determined the diagnostic performance of cervical ultrasound and defined an optimal threshold to predict a corticosteroid-delivery delay within7 days. Results. Our population consisted of 259 patients. The median cervical length was 15mm. The median time between corticosteroid and delivery was 35 days. More than 75% of births occurred more than 7 days after the cure, of which almost two-thirds were not preterm. The optimal threshold was 15mm. By administering corticosteroids only in cases of cervical length less than 15mm, the rate of false-negative in our population was 4.6%, versus 0 with the threshold of 25mm. The falsepositive rate was more than two times lower than the 25mm threshold (33% versus 75%). Conclusion. A decrease in the ultrasound threshold giving the indication of the course of antenatal corticosteroid could make it possible to avoid a large number of fetuses treated in excess.
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Master Thesis
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Marion Chesnais. Évaluation de l'utilité de la mesure échographique de la longueur du col utérin pour optimiser le moment de la corticothérapie anténatale en cas de travail prématuré. Médecine humaine et pathologie. 2018. ⟨dumas-02179203⟩

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