Cervicovaginal Secretions Research Articles

147: Cervico-vaginal cytokine profile through gestation as a tool to predict preterm birth in woman at increased risk of prematurity

To determine if pro and anti-inflammatory cytokine concentrations in the cervico-vaginal secretions through gestation are predictive of spontaneous preterm birth (SPTB) in women at increased risk of SPTB.

Comparison of Cervicovaginal Lavage, Cervicovaginal Lavage Enriched With Cervical Swab, and Vaginal Tampon for the Detection of HIV-1 RNA and HSV-2 DNA in Genital Secretions

We compared the performance of 3 collection methods for cervicovaginal secretions [cervicovaginal lavage (CVL), CVL enriched with a cervical swab (eCVL), and vaginal tampon (VT)] to identify the most reliable method for detection of cervicovaginal HIV-1 and herpes simplex virus type 2 (HSV-2). HIV-1 RNA (Nuclisens EasyQ; BioMerieux, Marcy-l'Etoile, France), HSV-2 DNA (real-time polymerase chain reaction), and microscopic blood and semen traces were detected in samples from 19 HIV-1-HSV-2-coinfected women seen at 4 weekly visits. HIV-1 RNA was detected in 49 (79%) of 62 eCVLs, 41 (61%) of 67 CVLs, and 27 (57%) of 47 VTs. Detection of HIV-1 RNA was higher in eCVL compared with CVL [45/58 (78%) vs. 32/58 (55%); risk ratio 1.41, 95% confidence interval 1.05 to 1.88]. Although more eCVLs were contaminated with microscopic blood (29%) than CVLs (22%) or VTs (7%), detection of HIV-1 RNA remained higher using eCVL compared with CVL (risk ratio 1.43, 95% confidence interval 1.02 to 2.02) in uncontaminated samples. HSV-2 DNA was detected in less than 10% of samples by each method but in 7 (37%) of 19 women overall by 1 or more methods.

Immunogenicity and tolerability of an HPV-16/18 AS04-adjuvanted prophylactic cervical cancer vaccine in women aged 15–55 years

The immunogenicity and safety of an HPV-16/18 AS04-adjuvanted vaccine were assessed in women aged 26–55 years and compared with women aged 15–25 years in a Phase III, non-randomised, open-label, age-stratified study. Overall the vaccine was well tolerated and 100% seropositivity was achieved 1 month after the third dose in all age groups. There was a high correlation between HPV-16 and HPV-18 antibody levels (IgG) in cervicovaginal secretions and sera, regardless of age. The HPV-16/18 AS04-adjuvanted vaccine induces a robust and persistent immune response in women >26 years of age and generates antibodies that transudate through the cervix epithelium.

Fetal fibronectin testing for reducing the risk of preterm birth

Fetal fibronectin (FFN) is an extracellular matrix glycoprotein localized at the maternal-fetal interface of the amniotic membranes, between chorion and decidua, where it is concentrated in this area between decidua and trophoblast. In normal conditions, FFN is found at very low levels in cervico-vaginal secretions. Levels greater than or equal to 50 ng/mL at or after 22 weeks have been associated with an increased risk of spontaneous preterm birth. In fact, FFN is one of the best predictors of preterm birth in all populations studied so far, and can help selecting which women are at significant risk for preterm birth. To assess the effectiveness of management based on knowledge of FFN testing results for preventing preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), MEDLINE (1966 to December 2007) and all references in identified articles. Randomized controlled trials of pregnant women between the gestational ages of 22 and 34 weeks screened with FFN for risk of preterm birth. Studies included are based exclusively on knowledge of FFN results versus no such knowledge, and we have excluded studies including women with only positive or only negative FFN results. All four authors assessed studies for inclusion and quality and extracted data. We identified 13 trials, of which five were eligible for inclusion. The five included studies randomized 474 women, of which 235 were randomized to knowledge and 249 to no knowledge of FFN.Preterm birth less than 37 weeks was significantly decreased with management based on knowledge of FFN results (15.6%) versus controls without such knowledge (28.6%; risk ratio 0.54; 95% confidence interval 0.34 to 0.87). All other outcomes for which there were available data (preterm birth at less than 34, 32, or 28 weeks; gestational age at delivery; birthweight less than 2500 grams; perinatal death; maternal hospitalization; tocolysis; steroids for fetal lung maturity; and time to evaluate) were similar in the two groups. No other maternal or neonatal outcome was available for meaningful analysis. Although FFN is commonly used in labor and delivery units to help in the management of women with symptoms of preterm labor, currently there is not sufficient evidence to recommend its use. Since this review found an association between knowledge of FFN results and a lower incidence of preterm birth before 37 weeks, further research should be encouraged.

IGFBP-1 Levels in Cervicovaginal Secretions before and after Amniocentesis

Background: To evaluate the levels of insulin-like growth factor-binding protein-1 (IGFBP-1) in cervicovaginal secretions before and after midtrimester amniocentesis and relate to clinical outcome. Methods: 100 consecutive amniocentesis procedures were studied. We measured the IGFBP-1 concentration by radioimmunoassay in a cervicovaginal specimen before and after mid-trimester amniocentesis. The post-amniocentesis occurrence of vaginal loss of fluid or blood and abdominal pain was assessed by questionnaire. Results: In 6 cases there was a 100-fold increase in IGFBP-1 levels after amniocentesis. Loss of fluid per vaginam occurred in 4 (67%) of these pregnancies, compared to 3.2% of pregnancies without significant surge (p < 0.0001). In addition, post-procedural abdominal pain was more common among women with increased IGFBP-1 levels after amniocentesis (50 vs. 14%, p = 0.05). Two (33%) of the 6 patients with increased IGFBP-1 after amniocentesis delivered prior to 37 weeks as a result of spontaneous preterm labor and/or preterm ruptured membranes, compared to 7 (7%) in the group without surge in IGFBP-1 (p = 0.09). Conclusion: Increased post-procedure IGFBP-1 levels are after mid-trimester amniocenteses are related to procedure-related complications like abdominal pain and subsequent amniotic fluid leakage.

Decreased cervicovaginal production of both IgA1 and IgA2 subclasses in women with AIDS.

Paired sera and cervicovaginal secretions from 35 HIV-1-infected women representing different CDC stages of HIV infection were evaluated for total IgA, IgA1 and IgA2, for IgA, IgA1 and IgA2 to gp160, and for albumin. Age-matched healthy women (n = 45) served as controls. The secretion rates of total IgA, IgA1 and IgA2 were evaluated by calculating their relative coefficients of excretion by reference to albumin. In HIV-infected women, total IgA1 and IgA2 in sera and in cervicovaginal secretions increased proportionately as early as stages II + III and more markedly at stage IV. By contrast, the secretion rates of total IgA IgA1 and IgA2 were markedly reduced in AIDS women, the IgA2 secretion rate decreasing significantly as early as stages II + III. This apparent discrepancy was probably the result of increased transudation of serum-borne immunoglobulins into the vaginal cavity, since albumin levels in cervicovaginal secretions increased significantly according to the stages of disease. HIV-reactive IgA antibodies in serum, as in cervicovaginal secretions, were principally found within the IgA1 subclass. In women at stage IV, a high local production of IgA1 to gp160 occurred in spite of the impairment of cervicovaginal IgA synthesis, probably because of marked genital HIV replication at advanced stages.

T12-P-02 Knowledge of sexually transmitted disease risk among women who have sex with women

Introduction Sexually transmitted diseases (STDs) are ones of the most frequent among infectious diseases. In pathogenesis of the diseases that can be transmitted during the sexual practices between women, the most important is the problem of infected cervicovaginal secretions’transfer. That transfer may happen directly during the vagina's mucosa contact or indirectly by digital-vaginal sexual practices or sex toys sharing. The task of the studies was to show risk awareness and STDs’knowledge among women having sex with other women. Methods To describe the problem the studies were done on 259 women group, of which 56% names themselves as homosexual, and 32% as bisexual. The survey was carried out using internet, through the web page for lesbians. The research was based on personal questionnaire; concerning socio-demographical data, question about sexuality and knowledge of STD. Results Almost half of the women participating in the studies considered the level of their knowledge of STDs infection prevention is good. Most of them (80%) reported that has never suffered on STD before. About 50% of the participants had problems to define infection risk in different sexual practices correctly, as well as to point out infection tracts and gates. The biggest problem for them was to connect typical symptoms with particular disease. However almost all participants assumed any STD's symptom appearance as an indication for immediate medical consultation. Conclusions Although the prevailing part of the participants were convinced to be well-informed about STDs, their knowledge was not very deeP - what can increase STDs infection risk.

Infection of Macrophages and Dendritic Cells with Primary R5-Tropic Human Immunodeficiency Virus Type 1 Inhibited by Natural Polyreactive Anti-CCR5 Antibodies Purified from Cervicovaginal Secretions

Heterosexual contact is the primary mode of human immunodeficiency virus (HIV) type 1 (HIV-1) transmission worldwide. The chemokine receptor CCR5 is the major coreceptor that is associated with the mucosal transmission of R5-tropic HIV-1 during sexual intercourse. The CCR5 molecule is thus a target for antibody-based therapeutic strategies aimed at blocking HIV-1 entry into cells. We have previously demonstrated that polyreactive natural antibodies (NAbs) from therapeutic preparations of immunoglobulin G and from human breast milk contain NAbs directed against CCR5. Such antibodies inhibit the infection of human macrophages and T lymphocytes by R5-tropic isolates of HIV in vitro. In the present study, we demonstrate that human immunoglobulins from the cervicovaginal secretions of HIV-seronegative or HIV-seropositive women contain NAbs directed against the HIV-1 coreceptor CCR5. Natural affinity-purified anti-CCR5 antibodies bound to CCR5 expressed on macrophages and dendritic cells and further inhibited the infection of macrophages and dendritic cells with primary and laboratory-adapted R5-tropic HIV but not with X4-tropic HIV. Natural anti-CCR5 antibodies moderately inhibited R5-tropic HIV transfer from monocyte-derived dendritic cells to autologous T cells. Our results suggest that mucosal anti-CCR5 antibodies from healthy immunocompetent donors may hamper the penetration of HIV and may be suitable for use in the development of novel passive immunotherapy regimens in specific clinical settings of HIV infection.

Etiology of sperm immunity in women

Sperm immunity in females can reduce the likelihood of natural conception, and sperm antibodies from female sera have been shown to inhibit IVF in humans and in several animal models. The etiology of sperm immunity in human females is unknown, but several possible mechanisms have been proposed, including cross-reactivity with microbial antigens and interferon gamma-mediated potentiation of the antisperm immune response in women whose male partners have sperm autoantibodies in their semen. This article reviews these ideas and postulates a novel hypothesis based on the potential for the generation of anti-idiotype antibodies in women whose partners have sperm antibodies in their semen.

REVIEW ARTICLE: Antimicrobial Polypeptides are Key Anti‐HIV‐1 Effector Molecules of Cervicovaginal Host Defense

Mucosal surfaces of the cervix and vagina are portals for heterosexual transmission of human immunodeficiency virus type 1 (HIV‐1) and, therefore, play a fundamental role in the pathogenesis of primary infection. Cationic antimicrobial polypeptides including defensins are the principal effector molecules of mucosal innate immunity against microbes and viruses such as HIV. In cervicovaginal secretions, antimicrobial polypeptides constitute the majority of the intrinsic anti‐HIV‐1 activity, synergism between cationic polypeptides is complex, and full anti‐HIV‐1 activity involves the complete complement of cationic polypeptides. Periods in which cationic antimicrobial polypeptide expression is reduced are likely associated with increased susceptibility to HIV‐1 infection. This review provides an overview of the role of cationic antimicrobial polypeptides in innate cervicovaginal anti‐HIV‐1 host defense, and discusses how hormones and bacterial infections can regulate their expression. Emphasis is placed on the θ‐defensin (retrocyclin) class of anti‐HIV‐1 peptides and their potential for development as topical microbicides to prevent HIV‐1 transmission.

214: Identification of hepatitis C virus in cervico-vaginal secretions of infected women

INFECTED WOMEN. KIRAN TAM TAM, ANTONIO SISON, OMAR BAGASRA, HIMA TAM TAM, DAVID JASPAN, Clinica Campesina Family Health Services, Obstetrics & Gynecology, Denver, Colorado, Robert Wood Johnson University Hospital Hamilton, Obstetrics & Gynecology, Hamilton, New Jersey, South Carolina Center for Biotechnology, Department of Biology, Orangeburg, South Carolina, North Shore University Hospital, Maternal Fetal Medicine, Manhasset, New York, Albert Einstein Medical Center, Obstetrics & Gynecology, Philadelphia, Pennsylvania OBJECTIVE: To provide evidence for heterosexual and perinatal (non-transplacental) transmission by demonstrating the presence of HCV in cervico-vaginal secretions of infected women. STUDY DESIGN: Six HCV infected women in the Albert Einstein Health Care Network were recruited during the period 9/00-5/01. Exclusion criteria included the following 1) patient is menstruating, 2) patient is medically unstable to obtain the necessary specimens, 3) patient is in active labor, 4) patient with premature rupture of the membranes, and 5) patient is obstetrically unstable to obtain necessary specimens. Patients who were co-infected with human immunodeficiency virus (HIV) or Hepatitis B virus were not excluded from the study. 20 cc of cervicovaginal lavage (CVL) was obtained from each patient. CVL specimens were divided into cellular and acellular components. RNA was isolated by a modified guanidinium thiocyanate phenol-chloroform technique with a commercially available kit (Ultraspec 2, Biotecx Laboratories, Houston, TX). RNA was subjected to reverse-transcriptase polymerase chain reaction (RT-PCR). Analysis of HCV quasispecies was conducted on the stable 5’ untranslated region. HCV sequences were compared by the single-stranded conformation polymorphism (SSCP) assay. The SSCP products were sequenced and the secondary RNA structures identified by the University of Rochester=s RNA structure program. Dual RNA/DNA in situ PCR at the single cell level was also used in identifying HCV. RESULTS: All six women were HIV positive and were not pregnant. In all six cases HCV was isolated in both the cellular and acellular components of the cervicovaginal lavage specimen.

Phase I study of a candidate vaccine based on recombinant HIV-1 gp160 (MN/LAI) administered by the mucosal route to HIV-seronegative volunteers: The ANRS VAC14 study

One goal of HIV vaccination is to achieve high mucosal levels of specific secretory IgA (SIgA). In order to elicit specific SIgA antibodies against human immunodeficiency virus type-1 (HIV-1), a vaccine must be administered by the mucosal route, to the nasal or vaginal mucosa for example. We report here the results of the first phase I, randomized, open-label trial designed to assess the mucosal tolerability and immunogenicity of a candidate vaccine (recombinant protein HIV-1 gp160MN/LAI with or without DC-Chol adjuvant) administered by the nasal or vaginal route. Thirty-four female volunteers with a mean age of 46 years were vaccinated. There were 465 adverse events, of which 65 were considered related to the vaccine. No severe adverse events were related to the vaccine, and no difference in terms of tolerability was observed between the sites of vaccination or between the vaccine formulations. None of the volunteers reported that study participation affected their intimate or broader social relationships. No anti-gp160 activity was found between week 4 and week 48 in serum, saliva, or cervicovaginal and nasal secretions. These results show that a mucosal HIV vaccine can be well tolerated when administered by the nasal or vaginal route.

Amphipathic DNA Polymers are Candidate Vaginal Microbicides and Block Herpes Simplex Virus Binding, Entry and Viral Gene Expression

Amphipathic DNA polymers are promising therapies for the prevention of HIV and genital herpes infections. Recent studies on a panel of such compounds indicated potent activity against HIV binding and entry. This current study was conducted to explore the anti-herpes simplex virus (HSV) activity of the same panel of compounds and to determine their mechanism of activity. The anti-HSV activity of a 40-nucleotide degenerate polymer (REP 9), a 40-nucleotide polycytidine amphipathic DNA polymer (REP 9C) and an analogue lacking amphipathic activity (Randomer 3) were compared in plaque reduction assays in the absence or presence of human genital tract secretions; the mechanisms of anti-HSV activity were explored. REP 9 inhibited HSV infection 10,000-fold, whereas Randomer 3 displayed no anti-HSV activity. The antiviral activity was independent of sequence but was dependent on size: the most potent activity was observed for analogues of 40 nucleotides in length. Mechanistic studies indicated that REP 9 and REP 9C blocked HSV-2 binding and entry, were active when added post-entry, inhibited viral gene expression and blocked HSV-induced apoptosis. Confocal microscopy studies showed rapid delivery of fluorescently tagged REP 9 and REP 9C into human epithelial cells, and delivery was significantly greater in infected cells as compared with uninfected cells. REP 9 exhibited no cytotoxicity and retained anti-HSV activity in the presence of cervicovaginal secretions and when virus was introduced in seminal plasma. REP 9 and REP 9C represent a novel class of antiviral agents that act by multiple mechanisms. These compounds warrant further development for systemic or topical delivery for the prevention and treatment of HIV and HSV.

Genetic and Phenotypic Features of Blood and Genital Viral Populations of Clinically Asymptomatic and Antiretroviral-Treatment-Naive Clade A Human Immunodeficiency Virus Type 1-Infected Women

In the present study, we assessed whether human immunodeficiency virus type 1 (HIV-1) genetic compartmentalization was associated with phenotypic CCR5 (R5) or CXCR4 (X4) coreceptor usage differences between the systemic and the genital viral populations. Four clinically asymptomatic and treatment-naïve clade A HIV-1-infected patients were selected from a cohort of 274 African women, because they were free of all the biological cofactors known to modify the kinetics of viral production in the genital tract. HIV RNA envelope sequences (V1 to V3) derived from plasma and cervicovaginal secretions (CVS) were amplified, subcloned, and sequenced. CCR5 or CXCR4 coreceptor usage was determined by production of recombinant viral particles, followed by single-cycle infection assays of indicator cell lines, using the tropism recombinant test. In these four selected patients, CVS-derived sequences appeared to be genetically distinct from blood-derived sequences (P < or = 0.001). Two patients were found to harbor virus populations with only the R5 phenotype in both compartments, whereas viruses using CXCR4 in addition to CCR5 were detected in two other patients. In particular, one woman harbored genital virus populations with mixed R5 and X4 phenotypes associated with peripheral blood populations with only the R5 phenotype. These results demonstrate genetic compartmentalization of HIV between the plasma and genital secretions of clinically asymptomatic, treatment-naïve, clade A-infected women. Also, for one patient, we report phenotypic coreceptor usage differences between the systemic (R5) and genital (R5/X4) viral populations. These features may be critical for the development of further mucosal vaccines, therapies, or new preventive strategies to block heterosexual transmission.

Early second-trimester inflammatory markers and short cervical length and the risk of recurrent preterm birth

This study aimed to analyze the associations between serum and cervicovaginal inflammatory markers and recurrent spontaneous preterm birth in a cohort study of 62 pregnant women with ≥1 prior early spontaneous birth. Serum samples and cervicovaginal swabs from the women were obtained at enrollment in early second trimester (week 12–25). Cervical length was measured by ultrasound and dicotomized in to short (≤25 mm) and long cervices (>25 mm). The study endpoints were spontaneous preterm birth before 35 weeks and secondarily < 37 weeks. Multiple inflammatory markers in serum (IL-1β, IL-2, IL-5, IL-6, IL-8, IL-12, IL-18, TNF-α, TGF-β, sTNF-R1, GM-CSF and TREM-1) and cervicovaginal secretions (IL-18, sTNF-RI and sIL-6) were individually associated with spontaneous preterm birth. Short cervical length did not explain associations between inflammatory markers and spontaneous preterm birth. Serum and cervicovaginal inflammatory markers did not correlate. In a combined prediction model using both serum and vaginal inflammatory markers, serum TNF-α, cervicovaginal sIL-6Rα and cervical length predicted 69% of all recurrent spontaneous preterm birth at a 5% false-positive rate. In conclusion, cervical length, serum TNF-α and cervicovaginal sIL-6Rα provide a clinically useful prediction of recurrent preterm birth in early second-trimester in women with a prior spontaneous preterm birth.

Intrapartum Transmission After Mucosal Exposure to HIV Was Not Observed With Single-Dose Nevirapine for Mother and Child

Intrapartum transmission of HIV has been reported to be associated with HIV in oropharyngeal secretions (OPSs) of the child. In this study, we analyze the frequency of intrapartum transmission after mucosal exposure to HIV after administration of single-dose nevirapine. Eighty mothers and their children participating in a prevention of mother-to-child transmission of HIV program in Uganda who took a single dose of nevirapine according to the HIVNET012 protocol participated in the study. HIV-1 was quantified by polymerase chain reaction (PCR) in the mothers' and children's plasma, in cervicovaginal secretions (CVSs), and in the children's OPSs. Intrapartum transmission was defined as a positive HIV-1 RNA PCR result at week 1 or 2 after birth and a previously negative PCR result. Ninety-seven percent of children had detectable nevirapine in their OPS (median = 592 ng/mL). Fifty-seven (81%) children had HIV-negative OPSs, and 13 (19%) had HIV-positive OPSs. All children of mothers with HIV-negative CVSs had HIV-negative OPSs. HIV-1 levels of OPSs and CVSs correlated (r = 0.33, P = 0.027). None of the babies with detectable HIV-1 in the OPSs became infected by means of intrapartum transmission. Intrapartum HIV infection was not observed after mucosal exposure to HIV-1 after administration of a single dose of nevirapine to the mother and child.

Negative mucosal synergy between Herpes simplex type 2 and HIV in the female genital tract

There is substantial epidemiological evidence that infection by Herpes simplex virus type 2 (HSV2) enhances both HIV susceptibility and subsequent sexual transmission. Both infections are extremely common in female sex workers (FSWs) in sub-Saharan Africa, and up to 80% of new HIV infections in urban men in the region are acquired via transactional sex. The present study aimed to elucidate the mucosal immune interactions between HIV and HSV2 in the genital tract. Endocervical immune cell populations, cytokine/chemokine protein levels in cervico-vaginal secretions and cervical immune gene expression profiles were measured in a well-defined cohort of HIV-infected and uninfected Kenyan FSWs. Associations between the genital immune milieu and infection by and/or shedding of common genital co-pathogens were examined. HIV-infected FSWs were much more likely to be infected by HSV2, and to shed HSV2 DNA in the genital tract. There was also a profound negative 'mucosal synergy' between these viruses. In HIV uninfected FSWs, HSV2 infection was associated with a ten-fold increase in cervical immature dendritic cells (iDC) expressing DC-SIGN, and a three-fold increase in cervical CD4+ T cells expressing CCR5. HIV infection was associated with iDC depletion in the cervix, and with increased HSV2 genital reactivation, which in turn was associated with HIV shedding levels. The findings suggest a mucosal vicious circle in which HSV2 infection increases HIV target cells in the genital mucosa, subsequent HIV infection impairs HSV2 mucosal immune control, and local HSV2 reactivation enhances both HSV2 and HIV transmission.

Measurement of Placental Alpha-Microglobulin-1 in Cervicovaginal Discharge to Diagnose Rupture of Membranes

To compare the accuracy of an immunoassay to measure levels of placental alpha-microglobulin-1 in cervicovaginal secretions with that of conventional clinical assessment for the diagnosis of rupture of membranes. A prospective observational study was performed in consecutive patients with signs or symptoms of rupture of membranes at Seoul National University Hospital from March 2005 to February 2006. Initial evaluation included both the standard clinical evaluation for rupture of membranes and placental alpha-microglobulin-1 immunoassay. Rupture of membranes was diagnosed if fluid was seen leaking from the cervical os or if two of the following three conditions were present: pooling of fluid, positive nitrazine test, or ferning. Rupture of membranes was diagnosed definitively on review of the medical records after delivery. Of 184 patients (11-42 weeks of gestation), rupture of membranes was diagnosed at initial presentation in 76% (139 of 184) using conventional clinical assessment and 88% (161 of 184) using placental alpha-microglobulin-1 immunoassay. Follow-up confirmed that a total of 159 of 183 patients (87%) had rupture of membranes at their initial presentations. Using this longitudinal assessment as the clinical gold standard, placental alpha-microglobulin-1 immunoassay confirmed rupture of membranes at initial presentation with a sensitivity of 98.7% (157 of 159), specificity of 87.5% (21 of 24), positive predictive value of 98.1% (157 of 160), and negative predictive value of 91.3% (21 of 23). Placental alpha-microglobulin-1 immunoassay was better than both the conventional clinical assessment and the nitrazine test alone in confirming the diagnosis of rupture of membranes. Measurement of placental alpha-microglobulin-1 in cervicovaginal secretions is superior to conventional clinical assessment in the diagnosis of rupture of membranes. II.

Human chorionic gonadotropin in cervicovaginal secretion as a predictor of preterm delivery

A prospective study was conducted with 150 women between the 24th and 34th weeks of a singleton pregnancy who had symptoms suggestive of preterm labor. The inclusion criteria were 4 regular uterine contractions per 20-min intervals accompanied by low back pain or low abdominal pain; pelvic pressure; and increased vaginal discharge. Exclusion criteria were ruptured membranes; vaginal bleeding; cervical dilatation of 4 cm or more; cervical cerclage in the present pregnancy; placenta previa; a history of trauma and tocolysis; pre-eclampsia; and fever (body temperature higher than 37.8 °C). There were 71 women (47.3%) delivered after 37 weeks of pregnancy (the group at term) and 79 (52.7%) delivered before 37 weeks of pregnancy (the preterm group). After a sample of cervicovaginal secretions was obtained the levels of human chorionic gonadotropin (hCG) present in the secretions were measured by immunoassay and compared between the 2 groups. (excerpt)

Prediction of Preterm Delivery among Women with Threatened Preterm Labor

Background/Aims: To determine predictive values of fetal fibronectin and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in cervicovaginal secretions and ultrasonographic measurement of cervical length for delivery <35 weeks in patients with uterine contractions. Methods: Our study included 51 women between 24 and 35 weeks’ gestation with uterine contractions and 90 controls. Cervicovaginal samples were analyzed for presence of fetal fibronectin and phIGFBP-1. Cervical length was measured by transvaginal sonography. Results: Preterm birth rate was 19.6% (10/51) in the study group. Negative predictive values of fetal fibronectin, phIGFBP-1 and ultrasonographic cervical length <20 mm, and <25 mm for delivery <35 weeks were 91.9, 92.3, 91.1, and 90.5%, respectively. Positive predictive values were 50, 58.3, 100 and 66.7%, respectively. When results of fetal fibronectin/phIGFBP-1 test and ultrasonographic cervical length <25 mm were combined, specificity and positive predictive values of each test for delivery within 7 days increased. Conclusion: Fetal fibronectin and phIGFBP-1 tests have approximately equivalent ability to predict delivery <35 weeks’ gestation. An ultrasonographic cervical length measurement >20 mm or a negative fetal fibronectin/phIGFBP-1 test obtained from patients with uterine contractions at 24–35 weeks’ gestation may avoid overdiagnosis.