Marker For Preterm Delivery Research Articles

Maternal BMI, 25-Hydroxyvitamin D serum level and Cervical Length Measurements: Markers for Preterm Delivery

ABSTRACT Background: Preterm delivery is the delivery between 20th - 37th weeks of gestation. The study aimed to study the maternal BMI, 25-Hydroxyvitamin D (25(OH)D) serum level, and uterine cervical length (CL) as predicting factors for PTD. Methods: A prospective study included 188 pregnant women recruited during 20th - 24th weeks of gestation. The maternal BMI was calculated, the serum level of 25(OH)D was measured, and the uterine CL was measured via transabdominal and transvaginal ultrasound. All women followed until delivery time and then were divided into 2 groups; group1 (n=54) women who delivered preterm, and group2 (n=134) women who delivered at term. Results: BMI results showed statistical significance between women who delivered preterm and those who delivered at term ‎(29.7±1.7 vs. 23.6±2.2 kg/m2, P 25kg/m2 had significantly longer cervix than those who had BMI <25kg/m2. Regarding the effect of CL on the mode of delivery, 65.4% of women with CL Conclusions: Maternal BMI had a significant relation with PTD. Measuring the CL during 20th - 24th weeks helps predict preterm delivery and the mood of delivery. There is an association between BMI and cervical length. Keywords: BMI; 25-Hydroxyvitamin D; Cervical Length; Preterm Delivery.

1125: First trimester stress and depression as risk factors for preterm birth

Mood disorders are most commonly screened for in late pregnancy and the postpartum period. However, both stress and depression have been linked to adverse pregnancy outcomes. We examined the relationship between early pregnancy patient-reported stress and depression measures and preterm birth (PTB). We performed a prospective cohort study, enrolling women in the 1st trimester and following them longitudinally to identify novel markers for preterm delivery at an academic tertiary care center. The Perceived Stress Scale (PSS) and the Edinburgh Perinatal Depression Scale (EDPS) were used to identify women with moderate/high stress and depression in the 1st trimester. The relationship between stress levels and depression and PTB was examined using logistic regression to control for pertinent confounders, including prior PTB, neighborhood deprivation (measured by area of deprivation index score > median), and black race. We included 848 women. Moderate to high stress in the 1st trimester is associated with a 50% increased risk for PTB < 37 weeks, even after controlling for confounders (OR 1.5, 95% CI 1.1-2.0; aOR 1.5, 95% CI 1.0-2.3) (Table 1). There was no significant association between stress and PTB < 34 weeks or spontaneous PTB. First trimester depression was also associated with significant risk for preterm birth, although this was not significant after controlling for confounders (aOR 1.5, 95% CI 0.9-2.5) (Table 2). Moderate to high stress in the 1st trimester is a potentially modifiable risk factor for preterm birth that can be addressed upon entry to prenatal care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1126: Early pregnancy stress and depression: differences among race and parity

Socioeconomic deprivation, stress, and depression are associated with poor pregnancy outcomes. How race and parity interact with social deprivation to influence stress and depression is unknown. In this analysis, we examined the association between high deprivation and maternal stress and depression in early pregnancy, as influenced by race and parity. This analysis was part of a prospective cohort study designed to identify novel markers for preterm delivery. Area of deprivation index (ADI) was derived from participants’ address using the “Neighborhood Atlas” (University of Wisconsin) and state census data. ADI score is based on various factors contributing to socioeconomic advantage/disadvantage (education, housing etc.) The Perceived Stress Scale (PSS) quantified stress and the Edinburgh Perinatal Depression Scale (EDPS) identified women with depression. Risk for moderate to high stress and depression were compared by level of ADI and were stratified by race and parity. We included 848 women. Those with ADI above the median were significantly more likely to report moderate/high stress levels (RR 1.4, 95%CI 1.2-1.6) and nearly 3 times more likely to be diagnosed with depression in the 1st trimester (2.9, 95%CI 2.0-4.0). The relationships between perceived stress and depression with ADI both above and below the median were not significantly different between black and nonblack women. However, parity demonstrated a significant interaction in the relationship between stress with ADI. The relationship between deprivation and stress was stronger in nulliparas than multiparas, who had higher but more stable stress levels across deprivation scores. The relationship between deprivation and depression did not differ by race or parity. High ADI is associated with significantly increased rates of stress and depression in early pregnancy, with over half of women at high deprivation reporting moderate/high stress and 20% screening positive for depression. ADI is a clinically obtainable characteristic that can target women at risk for high stress and depression in early pregnancy.

Estimation of preterm labor immediacy by nonlinear methods.

Preterm delivery affects about one tenth of human births and is associated with an increased perinatal morbimortality as well as with remarkable costs. Even if there are a number of predictors and markers of preterm delivery, none of them has a high accuracy. In order to find quantitative indicators of the immediacy of labor, 142 cardiotocographies (CTG) recorded from women consulting because of suspected threatened premature delivery with gestational ages comprehended between 24 and 35 weeks were collected and analyzed. These 142 samples were divided into two groups: the delayed labor group (n = 75), formed by the women who delivered more than seven days after the tocography was performed, and the anticipated labor group (n = 67), which corresponded to the women whose labor took place during the seven days following the recording. As a means of finding significant differences between the two groups, some key informational properties were analyzed by applying nonlinear techniques on the tocography recordings. Both the regularity and the persistence levels of the delayed labor group, which were measured by Approximate Entropy (ApEn) and Generalized Hurst Exponent (GHE) respectively, were found to be significantly different from the anticipated labor group. As delivery approached, the values of ApEn tended to increase while the values of GHE tended to decrease, suggesting that these two methods are sensitive to labor immediacy. On this paper, for the first time, we have been able to estimate childbirth immediacy by applying nonlinear methods on tocographies. We propose the use of the techniques herein described as new quantitative diagnosis tools for premature birth that significantly improve the current protocols for preterm labor prediction worldwide.

Prediction of preterm delivery using levels of vascular endothelial growth factor and leptin in amniotic fluid from the second trimester.

Impaired angiogenesis of the developing placenta in the early pregnancy is one etiology of preterm delivery. Vascular endothelial growth factor (VEGF) is a key regulator of normal angiogenesis. Leptin stimulates other angiogenic factors, including VEGF. In this study, we aimed to investigate whether levels of VEGF and leptin in amniotic fluid during the second trimester could serve as markers for preterm delivery. This study was conducted on second trimester amniotic fluid samples obtained from women undergoing genetic amniocentesis at 16-20 weeks of gestation. VEGF and leptin levels were measured by enzyme-linked immunosorbent assay in every case of delivery at <37 weeks' gestation (n = 36) and in 36 matched controls who delivered at ≥ 37 weeks' gestation. Amniotic fluid VEGF levels in the preterm group (32.24 ± 4.87 pg/ml) were significantly higher than those in the control group (23.49 ± 2.09 pg/ml) (p < 0.05). Leptin levels in the amniotic fluid were higher in the preterm group (6.64 ± 0.68 ng/ml) compared to the control group (5.35 ± 0.59 ng/ml), but this difference was not significant. Amniotic fluid VEGF and leptin levels were highest in women with placenta previa and were lowest in women with intrauterine growth retardation and pregnancy-induced hypertension. These results show that amniotic fluid VEGF levels in the second trimester are more predictive of preterm delivery than leptin levels. This study also demonstrates that VEGF levels vary depending on the cause of preterm delivery.

Fetal Fibronectin Signaling Induces Matrix Metalloproteases and Cyclooxygenase-2 (COX-2) in Amnion Cells and Preterm Birth in Mice

Fetal fibronectin (fFN) in cervical and vaginal secretions has been used as a predictor of preterm delivery. Here, we clarified the pathological function of fFN on cell type-specific matrix metalloproteinases (MMPs) and prostaglandin synthesis in fetal membranes. Treatment of amnion mesenchymal cells with fFN resulted in dramatic increases in MMP-1 and MMP-9 mRNA and enzymatic activity as well as COX-2 mRNA and prostaglandin E(2) synthesis, activating both NFκB and ERK1/2 signaling. Fetal FN-induced increases in MMPs and COX-2 were mediated through its extra domain A and Toll-like receptor 4 expressed in mesenchymal cells. Lipopolysaccharide and TNF-α increased the release of free FN in medium of amnion epithelial cells in culture. Finally, injection of fFN in pregnant mice resulted in preterm birth. Collectively, these results indicate that fFN is not only a marker of preterm delivery but also plays a significant role in the pathogenesis of preterm labor and premature rupture of fetal membranes.

Beta-human chorionic gonadotropin concentrations in cervicovaginal secretions as an early marker of preterm delivery

Amac: Preterm dogum erken belirteci olarak serviko-vajinal sekresyonlardaki koriyonik gonadotropin\'in rolunu arastirmak. Yontemler: Bir onceki dogumu erken dogum veya ikinci trimester dusuk oykusu risk faktoru olan, 25-36 gebelik haftasina sahip 55 gebe calismaya alindi. Hastalarin tumunde servikovajinal sekresyonlardaki beta-insan koriyonik gonadotropin (β-hCG) duzeyleri radioimmunassay yontemiyle ticari bir kit kullanilarak olculdu. Bulgular: Gebelerden 25\'i preterm, 30\'u term dogum yapti. Term ve preterm dogum yapana gebe gruplari arasinda yas, gebelik sayisi ve parite acisindan farklilik saptanmadi (P>0.05). Preterm dogum grubunda yenidogan APGAR skorlari ve bebeklerin antropometrik olcumleri term dogum grubundan anlamli dusuk bulundu (P

Diagnostic Accuracy of Cervicovaginal Interleukin-6 and Interleukin-6:Albumin Ratio as Markers of Preterm Delivery

Abstract Background: Absence of fetal fibronectin (fFN) in the cervicovaginal fluid (CVF) of women with symptoms of preterm labor is an excellent predictor of women who will not deliver within 2 weeks of testing. Preliminary studies suggest interleukin (IL)-6 performs similarly to fFN. The positive predictive values of both these assays are poor. Inconsistent specimen collection may explain this poor performance. The objective of this study was to validate the clinical utility of cervicovaginal IL-6 and investigate the utility of the IL-6:albumin ratio to predict delivery within 14 days. Methods: We quantified albumin and IL-6 with the DPC Immulite® in 660 CVF specimens collected for physician-ordered fFN analysis. The clinical utility of IL-6 and IL-6:albumin to predict delivery within 14 days of collection was determined. Results: The sensitivity, specificity, and positive and negative likelihood ratios for delivery within 14 days were 65%, 87%, 4.8, and 0.4, respectively, for fFN and 35%, 91%, 3.8, and 0.7 for IL-6, with a 250 ng/L cutoff. With a preterm delivery prevalence of 4.7%, positive and negative predictive values were 19% and 98%, respectively, for fFN and 16% and 97% for IL-6. The areas under the ROC curves were 0.71 and 0.51 for IL-6 and IL-6:albumin, respectively. Odds ratios for delivery within 14 days of collection were 11.8 (P &amp;lt;0.0001), 5.5 (P = 0.0001), and 2.4 (P = 0.06) for fFN, IL-6, and IL-6:albumin, respectively. Conclusions: Cervicovaginal IL-6 may have utility for predicting preterm labor while offering the potential for substantial cost savings. Assay performance characteristics are not improved by normalizing IL-6 to albumin.

Diagnostic Accuracy of Cervicovaginal Interleukin-6 and Interleukin-6:Albumin Ratio as Markers of Preterm Delivery

Absence of fetal fibronectin (fFN) in the cervicovaginal fluid (CVF) of women with symptoms of preterm labor is an excellent predictor of women who will not deliver within 2 weeks of testing. Preliminary studies suggest interleukin (IL)-6 performs similarly to fFN. The positive predictive values of both these assays are poor. Inconsistent specimen collection may explain this poor performance. The objective of this study was to validate the clinical utility of cervicovaginal IL-6 and investigate the utility of the IL-6:albumin ratio to predict delivery within 14 days. We quantified albumin and IL-6 with the DPC Immulite in 660 CVF specimens collected for physician-ordered fFN analysis. The clinical utility of IL-6 and IL-6:albumin to predict delivery within 14 days of collection was determined. The sensitivity, specificity, and positive and negative likelihood ratios for delivery within 14 days were 65%, 87%, 4.8, and 0.4, respectively, for fFN and 35%, 91%, 3.8, and 0.7 for IL-6, with a 250 ng/L cutoff. With a preterm delivery prevalence of 4.7%, positive and negative predictive values were 19% and 98%, respectively, for fFN and 16% and 97% for IL-6. The areas under the ROC curves were 0.71 and 0.51 for IL-6 and IL-6:albumin, respectively. Odds ratios for delivery within 14 days of collection were 11.8 (P <0.0001), 5.5 (P = 0.0001), and 2.4 (P = 0.06) for fFN, IL-6, and IL-6:albumin, respectively. Cervicovaginal IL-6 may have utility for predicting preterm labor while offering the potential for substantial cost savings. Assay performance characteristics are not improved by normalizing IL-6 to albumin.

Cervical gland area as an ultrasonographic marker for preterm delivery

Cervical gland area as an ultrasonographic marker for preterm delivery

Value of Endocervical Ureaplasma Species Colonization as a Marker of Preterm Delivery

Aims: To study the predictive value for preterm delivery of colonization of the cervix and vagina by ureaplasmas and other potentially pathogenic microorganisms. Methods: Prospective analysis of a study group of 200 pregnant women with preterm labor and intact membranes, and a control group of 50 pregnant women. The subjects in both groups were between 24 and 34 weeks of gestation. Ureaplasma spp. and Mycoplasma hominis endocervical cultures were performed for both groups. Results: In the study group, 70 of the women delivered preterm, and all women in the control group carried their pregnancies to full term. Cervical cultures for Ureaplasma spp. were positive in 119 women, and were isolated more frequently in the study group (51.5%) than in the control group (32%), and more frequently in subjects in the study group who delivered preterm (65%) than in those who had a full-term delivery (45%), differences that were statistically significant. Conclusion: Detection of Ureaplasma spp. in the endocervix has a statistically significant relationship to preterm labor (p = 0.03) and preterm delivery (p = 0.02) in pregnant women with preterm labor and intact membranes.

Total activin A in maternal blood as a marker of preterm delivery in low‐risk asymptomatic patients

To retrospectively evaluate whether increased serum levels of total activin A (t-activin A) are found in women who subsequently experience preterm delivery (PTD). Data on maternal serum t-activin A concentrations were available from a total of 84 singleton pregnant women and included 14 PTD pregnancies, each matched for gestational age and length of freezer storage, with 5 control pregnancies having term delivery (TD). Analyte values were expressed as multiple(s) of the control median. The median t-activin A for controls and cases was 1.00 +/- 0.45 and 1.27 +/- 0.53 MoM, respectively. Univariate analysis of the MoM values was performed using the Kaplan-Meier algorithm. Differences in the rate of delivery using a t-activin A MoM cut-off of > or = 1 SD (equivalent to 1.26 MoM) were analysed using the log rank test. The cumulative rate of PTD (< 37 weeks) was significantly higher for women with t-activin A concentrations > or = 1.26 MoM than those with t-activin A concentrations below this cut-off (40% vs.. 10%, p-value = 0.0218 log rank test). T-activin A concentration is higher in women who will develop PTD in a low-risk population. T-activin A values are inversely proportional to the time elapsed from blood test to delivery. Prospective studies would determine the precise discriminability of this marker for PTD and the best week for performing the blood test, allowing for a proper calculation of the detection rate and a positive predictive value.

Plasma CRH measurement at 16 to 20 weeks' gestation does not predict preterm delivery in women at high-risk for preterm delivery

The purpose of this study was to examine the utility of a single second-trimester plasma corticotropin-releasing hormone measurement as a marker for preterm delivery in women at high risk for preterm delivery. This is an analysis of data from a multicenter placebo-controlled trial designed to evaluate the role of 17 alpha hydroxyprogesterone caproate (17P) in the prevention of recurrent preterm birth. Women with a documented history of a previous spontaneous preterm birth at <37 weeks were enrolled (16-20 wks) and randomly assigned in a 2 to 1 ratio to weekly injections of 17P or matching placebo. Blood was collected before treatment in 170 patients (113 assigned 17P and 57 placebo) who were enrolled at 11 of the 19 centers. Plasma levels of corticotropin-releasing hormone were compared between those who delivered preterm and those delivering at term. Data were analyzed using the Wilcoxon rank-sum test. The overall rates of preterm birth in this cohort of 170 patients were 35.9% at <37 weeks (31.9% progesterone, 43.9% placebo), and 19.4% at <35 weeks (18.6% vs 21.1%). The median levels of corticotropin-releasing hormone were similar between those delivering at <37 weeks and those delivering > or = 37 weeks (0.39 ng/mL vs 0.37 ng/mL, P = .08). In addition, there were no differences in corticotropin-releasing hormone levels among those who delivered at <35 weeks or > or = 35 weeks (0.36 vs 0.38, P = .90). Moreover, there were no differences in corticotropin-releasing hormone levels among those in the placebo group who delivered at <37 or > or = 37 weeks (0.40 vs 0.41, P = .72) and at <35 or > or = 35 weeks (P = .64). A single measurement of corticotropin-releasing hormone at 16 to 20 weeks' gestation is not a good biomarker for recurrent preterm delivery in patients at high risk for this complication.

Maternal serum ferritin concentration in patients with preterm labor and intact membranes

Objective. To determine the relationship between maternal serum ferritin concentrations in the second trimester and the risk of preterm delivery (PTD).Methods. A prospective observational study was conducted. Fifty consecutive women with singleton pregnancies, who were admitted to the Maternal Fetal Medicine Unit due to preterm labor in the second trimester, were included. Maternal serum samples for determination of ferritin concentrations were obtained. Multiple logistic regression analysis was performed to control for confounders.Results. Out of fifty patients enrolled in the study, 38% (19/50) delivered prematurely. Eight women (16%) had maternal serum ferritin concentrations above 30 ng/ml in the second trimester. Among them, 75% (n = 6) subsequently presented with preterm delivery (odds ratio (OR) = 6.7 with 95% confidence interval (CI) 1.1–56.2, p = 0.04). Only two patients with increased maternal ferritin concentrations delivered at term. However, 13 patients with second trimester ferritin concentrations below 30 ng/ml had preterm delivery. No significant differences in mean maternal ferritin concentrations were found between patients who delivered preterm and those that delivered at term, 31.9 ± 50.6 vs. 13.6 ± 15.2, respectively (p = 0.064). Using a multivariable analysis, controlling for anemia, leucocytosis and maternal age, increased serum ferritin concentrations were found to be an independent risk factor for PTD (OR = 8.6; 95% CI 1.4–52.5; p < 0.019). No significant correlation was found between serum ferritin concentrations and gestational age at birth (Pearson correlation coefficient r = –0.093; p = 0.522).Conclusions. Maternal ferritin concentrations above 30 ng/ml in the second trimester can serve as a marker for preterm delivery. However, since no correlation was found between serum ferritin concentrations and gestational age at birth, the routine use of serum ferritin as a marker for preterm delivery warrants further investigation.

Predictive power of maternal serum and amniotic fluid CRP and PAPP-A concentrations at the time of genetic amniocentesis for the preterm delivery

Objective: To investigate whether maternal serum and amniotic fluid CRP and PAPP-A concentrations at the time of genetic amniocentesis are markers of preterm delivery. Study design: One hundred and forty-one pregnant women were included in this prospective study. Amniotic fluid and maternal serum CRP and PAPP-A concentrations were determined by using commercially available kits. Receiver-operating characteristic (ROC) analysis was performed to determine the efficacy of maternal serum and amniotic fluid CRP and PAPP-A levels in predicting women with preterm delivery. Results: The prevalence of spontaneous preterm delivery before 37 weeks of gestation was 9.9%. ROC analysis revealed that amniotic fluid CRP level was the only parameter, which had a significant power in the prediction of preterm delivery. The optimum cut-off level was 0.65 mg/L. The sensitivity and specificity were 92.9% and 78.7%, respectively. Conclusion: The amniotic fluid CRP level has a high sensitivity and specificity in the prediction of preterm delivery and this may be helpful in predicting preterm delivery during genetic amniocentesis.

Plasma CRH levels at 16-20 weeks do not predict preterm delivery in women at high-risk for preterm delivery

Corticotropin releasing hormone (CRH) levels have been identified in a general population as a marker for gestational length, with low levels associated with prolonged gestation and elevated levels associated with preterm delivery. The objective was to examine the utility of second-trimester plasma CRH measurement as a marker for preterm delivery in women at high risk for preterm delivery. A secondary analysis of data from a multicenter placebo-controlled trial to evaluate 17 α hydroxyprogesterone caproate (17P) in the prevention of recurrent preterm birth. Women with a history of a previous preterm birth at <37 wks were enrolled (16-20 wks) and randomly assigned in a 2 to 1 ratio to weekly injections of 17P or matching placebo. Of 463 women enrolled in the trial, plasma CRH was obtained prior to treatment in 169 patients (113 assigned 17-P, 56 placebo). Plasma levels of CRH were compared between those who delivered preterm and those delivering at term. Data were analyzed using the Wilcoxon Rank Sum test. Our sample size had 99% power to detect a 0.1 ng/mL difference in CRH for delivery <37 wks overall, and 80% power to detect a similar difference among placebo. CRH levels (mean ± SD) were similar between those delivering <37 and those delivering ≥37 wks (0.41 ± 0.12 ng/mL vs. 0.38 ± 0.12 ng/mL, P = .11), and those delivered at <35 or ≥35 wks (0.39 ± 0.12 vs. 0.40 ± 0.12, P = .68). There were no differences in CRH levels among those in the placebo group who delivered at <37 or ≥37 wks (0.42 ± 0.11 vs. 0.42 ± 0.17, P = .91) or at <35 wks (0.39 ± 0.11 vs. 0.43 ± 0.15, P = .34). There were no differences in baseline CRH levels between those assigned 17P and those assigned placebo (0.38 ± 0.11 ng/mL vs. 0.42 ± 0.14 ng/mL). The overall rates of preterm birth in this cohort of 169 patients were 35.5% at < 37 wks (31.9% 17P, 42.9% placebo), and 18.9% at <35 wks (18.6% vs. 19.6%). A single measurement of CRH at 16-20 wks gestation does not predict recurrent preterm delivery in high risk women with a prior preterm birth.

Amniotic fluid intercellular adhesion molecule-1 (ICAM -1) concentrations : A marker for impending intraamniotic infection with Ureaplasma and preterm delivery

CONCENTRATIONS : A MARKER FOR IMPENDING INTRAAMNIOTIC INFECTION WITH UREAPLASMA AND PRETERM DELIVERY SHULAMITH HOROWITZ, AMNON HADAR, NOA SHANI-SHREM, MOSHE MAZOR, Soroka University Medical Center, Microbiology and Immunology, National Center for Micoplasma, Israel, Beer Sheva, Israel, Soroka University Medical Center, Obstetrics and Gynecology, Beer-Sheva, Israel, Soroka University Medical Center, Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel OBJECTIVE: To determine the amniotic fluid ICAM-1 concentrations in women with preterm labor (PTL), according to the presence or absence of intraamniotic (IAI) infection. STUDY DESIGN: Amniotic fluid was obtained by amniocentesis from 132 women with PTL and the samples were examined for ICAM-1 concentrations and for intraamniotic infection with Ureaplasmas and other, less frequent, bacteria. Sixty eight women (51.5%) had preterm delivery (PTD) and 64 women had term deliveries. The statistical significance of the categorical variables was analyzed by c test, or Fisher’s exact test, when appropriate. Odds ratios (95% confidence intervals) were calculated. RESULTS: In the PTD group, 46% (31/68) had IAI with Ureaplasmas, compared to 20% (13/64) in the term delivery group (OR = 3.29, 95% CI 1.47.5; P= .002). The value of ICAM-1 used as the diagnostic cutoff was 1300 ng/ ml [as calculated from a Receiver Operating Characteristic (ROC) curve]. In women with PTD with IAI, 26% (8/31) had ICAM-1 levels above 1300ng/mL whereas none (0/37) in the PTD group without IAI attained this diagnostic level ( P= .001). In parturients with term delivery, there was no significant difference between those with or without IAI, (15% [2/13] had ICAM-1 >1300 ng/mL, compared with 3.9% [2/51], respectively [OR = 4.45, 95% CI 0.4-51.7; P = .13]). CONCLUSION: Amniotic fluid ICAM-1 concentrations exceeding 1300ng/mL might be used as a marker for IAI with Ureaplasma in patients with PTL.

Cervicovaginal interleukin-6, tumor necrosis factor-alpha, and interleukin-2 receptor as markers of preterm delivery.

Preterm delivery is a common obstetric problem (1), and infants born prematurely are at increased risk for long-term disability and death (2). Clinical indicators of preterm delivery are neither sensitive nor specific (3). Fetal fibronectin (fFN) testing of cervicovaginal fluid is the only Food and Drug Administration-cleared test for prediction of preterm delivery. A negative fFN test ( 99% negative predictive value for delivery within 7 or 14 days of testing (4)(5). The negative result enables physicians to avoid unnecessary interventions, but the fFN test is costly (more than $100 per test). Cytokines have been investigated as biomarkers of impending preterm delivery and may favor preterm birth by stimulating prostaglandin synthesis (6)(7). Increased serum and amniotic fluid concentrations of several cytokines have been reported in women with preterm labor (8)(9)(10)(11)(12). The use of cervicovaginal fluid has been suggested as an alternative to amniotic fluid testing because this fluid is thought to be released through mechanical or inflammation-mediated damage to the membranes or placenta before birth (13). Cytokines may be released into cervicovaginal fluid during the breakdown of the chorio-decidual adhesion or from an inflammatory reaction in the same area. Few studies have been performed on symptomatic women (14)(15)(16)(17)(18)(19)(20). The objective of this study was to examine the potential usefulness of cervicovaginal interleukin-6 (IL-6), tumor necrosis factor-α (TNFα), and interleukin-2 receptor (IL-2R) in the prediction of delivery in symptomatic women within 14 days of testing. This was a retrospective cohort study of samples for physician-ordered cervicovaginal fFN tests received by the Barnes-Jewish Hospital laboratory between February 2001 and December 2002. Cervicovaginal fluid was …

Fetal fibronectin—how useful is it in the prediction of preterm birth?

To determine the value of cervicovaginal fetal fibronectin as a marker for preterm delivery, a previously published meta-analysis was updated. Selection criteria confined the analysis to English-language original reports of prospective studies including women at <37 weeks' gestation with intact amniotic membranes. For the outcomes of delivery <37 or <34 weeks' gestation or delivery within 7, 14, or 21 days after fibronectin sampling, we calculated sensitivity and specificity rates for each study, for subgroups of studies, and for all studies combined. A total of 40 studies were included. Statistical heterogeneity was seen in the majority of calculations of combined results and a random-effects model was used in these cases. For the outcomes of delivery <37 and <34 weeks' gestation, overall sensitivity rates were 52% and 53%, and overall specificity rates were 85% and 89%, respectively. For the outcomes of delivery within 7, 14, and 21 days, we calculated sensitivity rates of 71%, 67%, and 59% and specificity rates of 89%, 89%, and 92%, respectively. For the subgroup of women with symptoms of preterm labour, sensitivity rates for delivery <37 and <34 weeks' gestation or delivery within 7, 14, and 21 days of 54%, 63%, 77%, 74%, and 70% and specificity rates of 85%, 86%, 87%, 87%, and 90% were calculated. Cervicovaginal fetal fibronectin is an effective short-term marker of preterm delivery, especially in women with symptoms of preterm labour. Because results appear to be heterogeneous in different studies, caution should be taken when they are applied to a specific population.

Fetal fibronectin—how useful is it in the prediction of preterm birth?

Objective To determine the value of cervicovaginal fetal fibronectin as a marker for preterm delivery, a previously published meta-analysis was updated. Study design Selection criteria confined the analysis to English-language original reports of prospective studies including women at <37 weeks' gestation with intact amniotic membranes. For the outcomes of delivery <37 or <34 weeks' gestation or delivery within 7, 14, or 21 days after fibronectin sampling, we calculated sensitivity and specificity rates for each study, for subgroups of studies, and for all studies combined. Results A total of 40 studies were included. Statistical heterogeneity was seen in the majority of calculations of combined results and a random-effects model was used in these cases. For the outcomes of delivery <37 and <34 weeks' gestation, overall sensitivity rates were 52% and 53%, and overall specificity rates were 85% and 89%, respectively. For the outcomes of delivery within 7, 14, and 21 days, we calculated sensitivity rates of 71%, 67%, and 59% and specificity rates of 89%, 89%, and 92%, respectively. For the subgroup of women with symptoms of preterm labour, sensitivity rates for delivery <37 and <34 weeks' gestation or delivery within 7, 14, and 21 days of 54%, 63%, 77%, 74%, and 70% and specificity rates of 85%, 86%, 87%, 87%, and 90% were calculated. Conclusion Cervicovaginal fetal fibronectin is an effective short-term marker of preterm delivery, especially in women with symptoms of preterm labour. Because results appear to be heterogeneous in different studies, caution should be taken when they are applied to a specific population.