Abstract
Objective: To assess the combined use of cervical length and cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in the prediction of preterm delivery in symptomatic women in next 14 days. Methods: Cervical length was prospectively measured in 58 consecutive singleton pregnancies with intact membranes and regular contractions at 24-36 weeks, and phIGFBP-1 was assessed. Demographic data was evaluated(history of previous preterm delivery, history of spontaneous abortion, parity, BMI, maternal age, Orthodox or Muslims). Results: Values of all variables were evaluated (demographic data, cervical length and values ofphIGFBP-1) alone and in combination with cervical length of ≤ 15 mm and more than 15 mm. In women with cervical length less than 15 mm/ /phIGFPB-1 was positive in 30 patients(22 of them delivered in 14 days). In women with cervical length less than 15 mm/phIGFBP-1was positive in 9 of delivered pregnant women in 14 days. In women with cervical length less than 25 mm/phIGFBP-1was positive in 26 patients (2 of them delivered in 14 days). In patients with cervical length more than 25 mm/ph IGFBP-1 was positive in 4 patients (2 of them delivered in 14 days). With logistic regression we confirmed that with OR 0.117 and CI 95% (0.046-0.295) and p < 0.01 odds for preterm birth among patients with negative phIGFBP-1 is 0.117 lower than the odds for preterm birth among patients with positive test results. With same test for p = 0.009 (p < 0.01) we confirmed with OR and CI 95% (0.06 to 0.671) that cervical length less than 25 mm is good predictor of preterm delivery with symptomatic patients. Probability for delivery in the following 14 days with patients with positive phIGFBP-1 and cervical length ≤ 15 mm is 0.88 or probability for not delivering in those patients is 0.12. In 88% patients with positive phIGFBP-1 and cervical length ≤ 15 mm will deliver in the following 14 days. Conclusions: In symptomatic women phIGFBP-1 may significantly improve the risk assessment for preterm delivery with cervical length and help to plan sub-sequent pregnancy management.
Highlights
Preterm delivery is the leading cause of neonatal mortality and morbidity
Women presenting with threatened preterm labor are often treated with hospitalization and the administration of tocolytics to avoid preterm delivery
Randomized studies on the use of tocolytics in threatened preterm labor have demonstrated a significant prolongation of pregnancy by about 7 days but no significant reduction in the incidence of preterm delivery, perinatal morbidity or mortality [1, 2]
Summary
Preterm delivery is the leading cause of neonatal mortality and morbidity. Women presenting with threatened preterm labor are often treated with hospitalization and the administration of tocolytics to avoid preterm delivery. Randomized studies on the use of tocolytics in threatened preterm labor have demonstrated a significant prolongation of pregnancy by about 7 days but no significant reduction in the incidence of preterm delivery, perinatal morbidity or mortality [1, 2]. A minority of the women presenting with threatened preterm delivery will deliver preterm [3]. Given the side effects of tocolysis and the costs of hospital admission, a proper and correct diagnosis of impending preterm delivery is crucial. There have been attempts to identify, among women presenting with uterine contractions, the subgroup with the highest risk of delivering preterm. There is a wealth of literature suggesting that cervical length measured by ultrasound and fetal fibronectin has the potential to improve the prediction of preterm delivery [4, 5, 6]
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