Abstract
Objectives: Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened preterm labor (TPTL) with intact membranes for duration till getting spontaneous labor (SL). Patients & Methods: 37 women presenting with TPTL underwent CVF samplings before digital examination and then underwent transvaginal ultrasonography for estimation of cervical length (CL). All women received fluid and anxiolytic therapy and if uterine contractions persisted, all had received tocolytic therapy with oral nifedipine or intravenous magnesium sulphate according to requirements. Incidence of SL within <48 hr, 2 - 7 and 7 - 14 days was recorded and related to CL and result of FFN and PAMG-1 tests. Results: Incidence of SL was 13.5%, 35.2% and 51.3% within 48-hr, 2 - 7 and 7 - 14 days, respectively. Duration till labor after sampling was positively correlated with CL, while was negatively correlated with positive FFN and PAMG-1 tests. Positive FFN test had high specificity, while positive PAMG-1 test had high sensitivity for labor within 7 days. Regression analysis defined short CL and positive PAMG-1 test as significant predictors for short duration till SL. ROC curve analysis defined short cervix and positive PAMG-1 test as significant predictors for labor within 48-hr and within 2 - 7 days respectively and combined negative PAMG-1 test and CL of 20 - 25 mm were significant predictors for labor within 7 - 14 days. Conclusion: PAMG-1 test had high specificity, if positive, for predicting SL and high NPP, if negative, for excluding labor within 7 days, so it can be used as rapid adjuvant to clinical evaluation to help management decision-making. Moreover, PAMG-1 test is recommended screening test for being easy-to-use bedside test, provides rapid results, can be used after vaginal exam and coitus and does not require a speculum examination or specialized equipment to analyze results.
Highlights
Threatened preterm labor (TPTL) can be defined as the occurrence of regular uterine contractions before completion of 37 gestational weeks (GW) at rate of one contraction per ten minutes and persists for more than 30 minutes without cervical dilatation [1]
Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened preterm labor (TPTL) with intact membranes for duration till getting spontaneous labor (SL)
FFN can be detected in cervico-vaginal fluid (CVF) in all pregnancies before 22 GW, but between 24 and 34 GW indicates a risk of impending PTL [8] when its concentration in CVF is ≥50 ng/ml, but it showed no adequate sensitivity or specificity to predict a delay of labor at term [9]
Summary
Threatened preterm labor (TPTL) can be defined as the occurrence of regular uterine contractions before completion of 37 gestational weeks (GW) at rate of one contraction per ten minutes and persists for more than 30 minutes without cervical dilatation [1]. Risk stratification in women with preterm contractions would allow targeting of interventions to women who will deliver preterm and avoiding unnecessary treatments, associated with potential complications, in symptomatic women who are unlikely to deliver preterm [3]. Cervical length (CL) measurement in women with TPTL showed modest accuracy for predicting PTB [4] and combined with fetal fibronectin (FFN) testing may allow risk stratification for spontaneous delivery in women still pregnant 7 days after TPTL [5]. For prediction of PTL within 7 days, quantitative FFN measurement was not superior to qualitative test with CL, but added more costs [10]. Blood-stained swabs of CVF for FFN testing were still effective for predicting PTL, but had higher false positive rates [12]
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