Interleukin 6 and fetal fibronectin as a predictors of preterm delivery in symptomatic patients

Marija Hadzi Lega,Ana Daneva Markova,Milan Stefanovic,Mile Tanturovski

doi:10.17305/bjbms.2015.1.93

Abstract

Preterm delivery is the leading cause of neonatal mortality and morbidity. The rate of preterm births has been estimated to be about 15 million, which accounts for 11.1% of all live births worldwide. The purpose of this study was to evaluate the cervico-vaginal (CVF) cytokine IL-6 and fetal fibronectin (fFN) status as predictors of preterm delivery in patients with symptoms of preterm labor. Patients with symptoms suggestive of preterm labor were recruited from September 2013 to March 2014. Vaginal swabs were taken for fetal fibronectin test (fFN) and CVF IL-6. Antibiotics, steroids and tocolytics were administered, where appropriate. The outcome was measured by the occurrence of preterm delivery within 14 days from the day of hospital admission. Cut-off value of 1305 pg/mL for the concentration of IL-6 in the CVF was the best predictor of preterm delivery, with the sensitivity of 69.4% and specificity of 68.2%. Patients with positive fFN test had the OR of 6.429 (95%CI 1.991-20.758) to deliver prematurely. The multivariate analysis of combined fFN and CVF IL-6 tests resulted in risk of 86.7% to deliver prematurely, if both tests were positive. The combination of both tests performed better than the individual tests and decreased the false positive rate, which in turn reduced the chances for inappropriate patient treatment, bringing down the costs.

Highlights

Preterm delivery is defined as the delivery before completing 37 weeks of gestation
Women were not included if they had ruptured membranes, hemorrhage, active labor, a cervical cerclage in place and suspected chorioamnionitis, defined by fever, abdominal pain and leukocytosis. They were treated according to usual hospital protocol, with additional vaginal swabs taken for fetal fibronectin (fFN) and cervicovaginal interleukin 6 (IL-6)
We evaluated the number of previous spontaneous abortions, parity and smoking habits of the patients with threatened preterm labor

Summary

Introduction

Preterm delivery is defined as the delivery before completing 37 weeks of gestation. It is and a leading cause of neonatal mortality and morbidity worldwide. The rate of preterm births has been estimated to be about 15 million, which accounts for 11.1% of all live births worldwide [1]. Most randomized studies on the use of Submitted: 14 August 2014 / Accepted: 5 October 2014 tocolytics for treatment of threatened preterm labor demonstrate a significant delay in delivery of about 7 days, but no significant reduction in the incidence of preterm delivery and consequential neonatal mortality and morbidity [2,3]. Detection and confirmation of preterm labor is difficult, since the initial symptoms are often mild, and the later symptoms manifest when the process is beyond intervention

Objectives

Methods

Results

Conclusion