Возможности ультразвуковой диагностики в предикции спонтанных преждевременных родов (обзор литературы)

Преждевременные роды (ПР) являются основной причиной неонатальной и младенческой заболеваемости и смертности. В настоящем обзоре обобщены современные достижения ультразвуковой диагностики в предикции спонтанных ПР. Особое внимание уделено методологии трансвагинальной цервикометрии, а также другим ультразвуковым маркерам, таким как “сладж”, маточно-цервикальный угол, железистая зона шейки матки, оценка оболочек, эластография и маркеры фетального ответа. Также подчеркивается необходимость разработки стандартизированных протоколов и выполнения валидационных исследований для повышения воспроизводимости и эффективности применения используемых ультразвуковых маркеров предикции спонтанных ПР.

К настоящему времени доказано, что выполнение ультразвуковой цервикометрии с 15-й по 24-ю неделю гестации эффективно прогнозирует экстремально ранние ПР вследствие истмико-цервикальной недостаточности (ИЦН), однако стандарт исследования часто не соблюдается в рутинной практике.

Спорным остается использование параметров эластографии, маточно-цервикального угла и железистого индекса в качестве предикторов ПР вследствие ИЦН, оценки плодных оболочек, наличия “сладжа” и оценки органов плода в качестве предикторов ПР инфекционного генеза. Хотя указанные признаки имеют определенный потенциал для выделения группы риска ПР, их прогностическая ценность не превышает прогностическую ценность трансвагинальной цервикометрии, что определяет необходимость разработки моделей на основе многофакторного анализа.

Заключение. Учитывая полиэтиологичность синдрома ПР требуются дальнейшие исследования для выявления самостоятельных высокоинформативных ультразвуковых предикторов с учетом вероятной этиологии ПР и их сочетаний с иными клиническими и лабораторными признаками в многофакторных моделях прогнозирования. Это позволит своевременно и дифференцированно проводить профилактику спонтанных ПР у пациенток высокого риска, а в случае необходимости – организовать их маршрутизацию в специализированные центры, где может быть оказана высокотехнологичная помощь недоношенным новорожденным с низкой массой тела.

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