Abstract
Objective: To compare PAMG-1 and phIGFBP-1 tests in predicting impending spontaneous preterm delivery within 7 days upon presentation in pregnant women with symptoms of preterm labor. Study Design: From September 2014 to April 2015 women with singleton gestation, symptoms of preterm labor, GA 22 - 35, participated in this prospective cohort study upon admission. Recruited patients had intact membranes and a minimal cervical dilatation of ≤3 cm. Vaginal swabs for phIGFBP-1 and PAMG-1 were taken in addition to routine treatment. Biochemical test results were blinded and had no effect on management of patients. Results: A total of 96 patients were screened for inclusion into the trial; 57 met the inclusion criteria for final analysis. The PAMG-1 test was positive in 5.7% of patients, while phIGFBP-1 test was positive in 29.8% of patients. The prediction of spontaneous preterm delivery within 7 days of admission in patients with a cervical length < 25 mm (30%), the PAMG-1 test and phIGFBP-1 test showed a SN of 100% and 100%; SP of 83.3% and 50.0%, (p ≤ 0.05); PPV of 71.4% and 45.5%; and NPV of 100% and 100%. 89.5% of women who received corticosteroids and 84.2% of women who received tocolysis did not go into preterm labor within one week. Conclusion: Our study supports the high negative predictability of biochemical tests to rule out spontaneous preterm labor in patients with a short cervix. However, our study strongly suggests that the PAMG-1 test is more accurate for predicting imminent spontaneous preterm delivery as compared to phIGFBP-1. These findings can significantly reduce economic burden caused by unnecessary admission and treatment of patients suspected of preterm labor. Such a reduction in the use of corticosteroids and tocolytics would lead to a reduction in the short and long term health effects associated with the use of therapeutic drugs like corticosteroids, antibiotics and tocolytics.
Highlights
The worldwide preterm birth rate ranges from about 5% in several European countries to 18% in some African countries [1]
The prediction of spontaneous preterm delivery within 7 days of admission in patients with a cervical length < 25 mm (30%), the placental alpha microglobulin-1 test (PAMG-1) test and phIGFBP-1 test showed a SN of 100% and 100%; SP of 83.3% and 50.0%, (p ≤ 0.05); positive predictive value (PPV) of 71.4% and 45.5%; and negative predictive value (NPV) of 100% and 100%. 89.5% of women who received corticosteroids and 84.2% of women who received tocolysis did not go into preterm labor within one week
Our study revealed that only 29% of patients presenting with (i) symptoms of preterm labor, (ii) with a sonographically short cervix (
Summary
The worldwide preterm birth rate ranges from about 5% in several European countries to 18% in some African countries [1]. As many as 28% of pregnant patients presenting with signs and symptoms of PTL are admitted to the hospital [2], but only as few as 5% of these women will deliver within 7 days [3] [4]. Approximately 85% of patients admitted to the hospital for impending PTL do not deliver within the 7 days [5]. This statistic highlights the urgent need for more accurate ways to identify those women with a true risk of impending spontaneous preterm birth (PTB), defined as birth prior to the completion of the 37th week of gestation, to avoid unnecessary administration of potentially harmful therapeutics. It is important to time their administration within seven days of delivery to have the optimal impact on the fetus
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
