Объем шейки матки, оцененный по ультразвуковому исследованию, как предиктор успешной родовой деятельности: систематический обзор и метаанализ
https://doi.org/10.47093/2218-7332.2025.1223
Аннотация
Цель. Сравнить объем шейки матки у пациенток с успешной и неуспешной индукцией родовой деятельности (ИРД).
Материалы и методы. Систематический обзор и метаанализ выполнен в соответствии с рекомендациями PRISMA. Поиск литературы проводился в базах PubMed, EMBASE, Scopus и Google Scholar для выявления когортных исследований, опубликованных в период с 1 января 2005 по 31 декабря 2024 года, в которых сравнивался объем шейки матки у беременных женщин, перенесших ИРД. Для метаанализа использовали модель со случайными эффектами.
Результаты. В анализ включены семь исследований с участием 534 беременных женщин. В четырех исследованиях выявлен низкий риск систематических ошибок, в двух – высокий; в одном исследовании оценка риска не выполнена из‑за отсутствия полного текста. При объединенном анализе двух исследований (n = 168) обнаружена положительная связь между меньшим объемом шейки матки и успешными естественными родами в течение 24 часов (отношение шансов 7,19; 95% доверительный интервал: 3,31–15,64; I² = 0%). При объединенном анализе пяти исследований (n = 422) не выявлено статистически значимой разницы между успешной и неуспешной ИРД (разница средних –1,32 см³; 95% доверительный интервал: –8,37–5,72; I² = 89,8%). Анализ подгрупп не выявил статистически значимой связи между объемом шейки матки и успешной ИРД при определении исхода как естественные роды без ограничения по времени или продолжительностью до 24 часов. Вместе с тем существенно меньший объем шейки матки отмечен у женщин, достигших активной фазы родов в срок до 12 часов. Тест Эггера подтвердил отсутствие публикационных смещений (коэффициент = 0,50; стандартная ошибка = 1,75; p = 0,78).
Заключение. Определение объема шейки матки в качестве параметра для прогнозирования успешной ИРД обладает значительным потенциалом; меньшие значения ассоциируются с лучшими исходами, хотя результаты анализа подгрупп остаются неоднозначными.
Об авторах
П. Кассаянан
Университет Сринакаринвирот
Таиланд
Таиланд
Кассаянан Потсаноп, студент медицинского факультета
ул. Сукхумвит 23, д. 114, район Ваттана, г. Бангкок, 10110
К. Нонтапром
Университет Сринакаринвирот
Таиланд
Таиланд
Нонтапром Касидис, студент медицинского факультета
ул. Сукхумвит 23, д. 114, район Ваттана, г. Бангкок, 10110
П. Чантабал
Больница Клонг Луанг
Таиланд
Таиланд
Чантабали Праме, врач-гинеколог отделения акушерства и гинекологии
M.7 Клонг Хок, д. 30, район Клонг Луанг, г. Патхумтхани, 12120
С. Танасантумронгсак
Университет Сринакаринвирот
Таиланд
Таиланд
Танасантумронгсак Свитта, студент медицинского факультета
ул. Сукхумвит 23, д. 114, район Ваттана, г. Бангкок, 10110
М. Сунтипап
Университет Сринакаринвирот
Таиланд
Таиланд
Сунтипап Мончай, врач и преподаватель кафедры акушерства и гинекологии
ул. Сукхумвит 23, д. 114, район Ваттана, г. Бангкок, 10110
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Рецензия
Sechenov Medical Journal. Editor's checklist for this article you can find here.
Название / Title | Объем шейки матки, оцененный по ультразвуковому исследованию, как предиктор успешной родовой деятельности: систематический обзор и метаанализ / Ultrasonography cervical volume as a predictor of successful induction of labor: a systematic review and meta-analysis |
Раздел / Section
| АКУШЕРСТВО И ГИНЕКОЛОГИЯ / ОBSTETRICS AND GYNECOLOGY |
Тип / Article | Систематический обзор / Systematic review |
Номер / Number | 1223
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Страна/территория / Country/Territory of origin | Таиланд / Thailand |
Язык / Language | Английский / English
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Источник / Manuscript source | Инициативная рукопись / Unsolicited manuscript |
Дата поступления / Received | 30.04.2025 |
Тип рецензирования / Type ofpeer-review | Двойное слепое / Double blind |
Язык рецензирования / Peer-review language | Английский / English |
РЕЦЕНЗЕНТ А / REVIEWER A
Инициалы / Initials | 1223_А
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Научная степень / Scientific degree | Кандидат медицинских наук / Cand. of Sci. (Medicine)
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Страна/территория / Country/Territory | Россия / Russia
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Дата рецензирования / Date of peer-review | 30.06.2025
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Число раундов рецензирования / Number of peer-review rounds | 2 |
Финальное решение / Final decision | принять к публикации / accept
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ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW
Scientific quality: Grade B: Good
Language quality: Grade B (Minor language polishing)
Re-review: Yes
This meta-analysis addresses a clinically important question: identifying predictors of successful induction of labor to reduce maternal and fetal risks. The study design is robust, adhering to PRISMA guidelines and PROSPERO registration, with a comprehensive search across databases. The inclusion of seven prospective cohort studies and subgroup analysesfor varying definitions of success strengthens its relevance to clinical decision-making.
Comments
1) association between cervical volume and IOL success reverses direction depending on outcome timing (smaller volume linked to success in some subgroups, larger in others), creating conflicting conclusions. This issue should be thoroughly addressed in limitations and discussion.
2) Results of Deeks’ funnel plot and Egger’s test are mentioned but not reported, limiting assessment of potential bias.
3) High heterogeneity (Heterogeneity Index up to 89%) and inclusion of only seven studies weaken confidence in pooled estimates. Authors encouraged to address this issue in limitations.
4) Two studies rated as high risk, and geographic diversity is limited (most from Asia), raising concerns about generalizability.
5) The abstract/conclusion emphasizes smaller cervical volume as beneficial despite conflicting subgroup results.
Recommendation after the first round of peer-review: major revision and re-review.
ВТОРОЙ РАУНД РЕЦЕНЗИРОВАНИЯ /SECOND ROUND OF PEER-REVIEW
All comments have been addressed by authors.
РЕЦЕНЗЕНТ B / REVIEWER B
Инициалы / Initials | 1223_В
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Научная степень / Scientific degree | Кандидат медицинских наук / Cand. of Sci. (Medicine)
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Страна/территория / Country/Territory | Россия / Russia
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Дата рецензирования / Date of peer-review | 30.05.2025 |
Число раундов рецензирования / Number of peer-review rounds | 1 |
Финальное решение / Final decision | Принять к публикации после небольшой доработки/ Minor revision
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ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW
Scientific quality: Grade B: Good
Language quality: Grade B (Minor language polishing)
Re-review: No
The authors conducted a high-quality systematic review and meta-analysis. Its methodology and composition raises only a few minor issues:
Q1. Line 429. The sentence “The modified NOS evaluated six studies but limited data for
diagnostic perfor-mance evaluation using the QUADAS-2 tool” is not quite clear. The authors are suggested to rephrase it and to detail why this tool was not applicable.
Q2. The authors may consider re-structuring the manuscript: risk of bias seems to be more appropriate after the section “Characteristics of included studies”. Table 4 may be moved to supplementary material as this data is shown at Figure 3.
РЕКОМЕНДАЦИИ НАУЧНЫХ РЕДАКТОРОВ ЖУРНАЛА / RECOMMENDATIONS
OF THE SCIENTIFIC EDITORS OF THE JOURNAL
Main text
- To ensure that the main findings, clinical relevance and novelty of the study are clearly and concisely communicated to the reader, it is necessary to add three to five key highlights of the paper. These highlights improve the article’s visibility and facilitate rapid appraisal by clinicians and researchers conducting focused literature searches.
- A traffic light plot for the risk-of-bias assessment should be provided, as this visual representation allows readers and reviewers to easily evaluate the methodological quality of the included studies. This is an essential element of high-quality systematic reviews, contributing to greater transparency and reproducibility of the findings.
- Funnel plots and the results of Egger’s test must be included to assess potential publication bias. These analyses strengthen the credibility and robustness of the meta-analysis, demonstrating that the authors have critically evaluated the risk of systematic distortion in the available evidence.
Technical requirements
- To ensure transparency, accountability, and accurate indexation in scientific databases, including PubMed, it is necessary to provide full information for all authors, including academic degree and title (if applicable), position, and place of work (or study). Providing complete author details also ensures compliance with international publication standards, including the recommendations of the International Committee of Medical Journal Editors (ICMJE).
- Submitting all figures as separate, high-quality files ensures clear and accurate visualization in both the online and print versions of the journal. Low-resolution or poor-quality images may compromise readability, reduce the scientific value of the article and affect its suitability for indexing negatively.
- It is essential to provide Figure 1 in an editable format (e.g. PPTX) rather than as a screenshot to ensure professional layout and consistent formatting. Editable files allow technical adjustments to be made during the production process, whereas screenshots cannot be modified without loss of quality.
- The reference list must be formatted in accordance with Vancouver style to ensure consistency, a professional presentation, accurate database indexing and compliance with the journal's editorial policy and international standards.
- Providing the DOI and PMID (if available) for each reference is essential to facilitate accurate indexing in international databases, enabling readers to locate the original sources efficiently, a key requirement of high-quality scientific publishing.
References
- To reflect the current state of knowledge and ensure that the review is based on the most up-to-date and relevant evidence, it is necessary to add recent studies to the reference list, with the majority of references preferably published within the last five years.
- As most of the included studies originate from Asia, it is important to clarify whether this topic has been investigated in other regions. The geographic diversity of the included studies should be increased, or a clear justification for the current regional focus should be provided. Overrepresentation of a single region may introduce geographical or population bias, limiting the generalizability of the conclusions. Addressing this issue would significantly strengthen the study's scientific validity.
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