Prediction Of Spontaneous Preterm Delivery Research Articles

TVS-guided cervical strain elastography is more effective than measuring cervical length as an independent predictor of spontaneous preterm delivery in asymptomatic, high-risk women during the mid-trimester

Introduction TVS (Transvaginal Sonography) guided Cervical strain elastography (CSE) is now available in tertiary referral centers of LMICs (Low- and Middle-Income Countries). TVS cervical length (CL) assessment is being used routinely. Still, elastography is not used in clinical settings, although enough evidence suggests good predictive value towards sPTD (spontaneous Preterm Delivery). The clinical utility of elastography has not been tested among high-risk populations of LMICs for the prediction of sPTD. Aim To test the performance of TVS-CSE in predicting sPTD among asymptomatic women in the mid-trimester at risk of sPTD either due to clinical factors or due to a short cervix. Method Prospective observational study performed at a tertiary hospital in South India. Asymptomatic pregnant women between 16 and 24 weeks who had one or more clinical risk factors for sPTD or CL <2.5 cm were included. GE Voluson E-8 ultrasound machine was used. After CL measurement, elastography color coding was noted around the internal-os in the sagittal view. The strain ratio (SR) was calculated using the trace method on three ROIs (Region of Interest): Internal-os in sagittal view (IN), whole cervix in sagittal view (WN), and internal-os in axial view (AN). Reference Tissue (RT) of similar size and depth was chosen in the darkest blue region on elastography (stiffest area) outside the cervix, posterior/lateral to the cervix over the ligament insertion. Lower the SR – softer the cervix. Two trained fetal medicine consultants performed the initial 57 cases until intra/inter-observer correlation was satisfactory. Delivery before 37 weeks (after 26 weeks), in which the process of labor has begun spontaneously, or labor was induced after PPROM—was considered as sPTD. SRs were assessed to determine how well they could predict sPTD independently or combined with cervical length. Results Out of 221 recruited,17 were lost to follow-up after 32 weeks; 204 were delivered in our hospital. Irrespective of the route of delivery, 71 (34.8%) had sPTD. Of the remaining 133, 106 delivered at term, and 27 underwent medically indicated PTD. Apart from multiple pregnancies, no other preterm-related risk factors (including CL < 2.5 cm) showed significant association with sPTD. Red CSE pattern around internal-os was associated with a significantly higher (54.5%) incidence of sPTD. CLs were similar (3.63 ± 0.67 vs. 3.63 ± 0.80, p = .981) whereas SRs in all three ROIs were significantly lower among sPTD group versus no sPTD group (IN:0.65 ± 0.29 vs 0.79 ± 0.30 p = .001, WN:0.34 ± 0.13 vs 0.39 ± 0.15, p = .013, AN:0.37 ± 0.16 vs 0.48 ± 0.26, p = .002, respectively). Using ROC curves, while CL was not predictive (AUROC 0.49, p = .81), SRs showed moderate predictive value toward sPTD with the best AUC of 0.624 (p = .003) at IN. Prediction was slightly better for early sPTD <32 weeks (AUC 0.653 p = 0.03). The best cutoff for SR at IN was 0.72, below which there was a moderate accuracy in predicting sPTD (sensitivity 52.11%, specificity 60.9%, PPV 41.57%, NPV 70.44%, diagnostic OR 1.69 and overall accuracy of 57.84%). A weak positive correlation is seen between IN and CL (Pearson’s correlation R = 0.181). Multi-variable binary logistic regression analysis suggested that SRs at IN (Adjusted OR − 0.259 CI 0.079–0.850), AN (Adjusted OR 0.182 CI 0.034–0.963), Multiple Pregnancy (Adjusted OR 3.5 CI 1.51–8.13) and previous sPTD/PPROM (Adjusted OR 2.72 CI 0.97–7.61) independently predicted sPTD. Conclusions TVS CSE performed better than CL as an independent predictive tool toward sPTD, although predictive efficacy was modest at best. Since technology is now available in high-end USG machines in tertiary care centers, we propose optimal utilization of CSE in LMICs to triage at-risk populations since low SRs are strongly associated with sPTD.

A prospective, double-blinded cohort study using quantitative fetal fibronectin testing in symptomatic women for the prediction of spontaneous preterm delivery

BackgroundSpontaneous preterm birth (PTB) affects 6.5% of deliveries in Hong Kong. Quantitative fetal fibronectin (fFN) is under-utilised as a test for PTB prediction in Hong Kong. Our objective was to evaluate the effectiveness of quantitative fFN in predicting spontaneous PTB in women with symptoms of threatened preterm labour (TPTL) in our population.MethodsA prospective, double-blinded cohort study of women with a singleton gestation and TPTL symptoms presenting to a tertiary hospital in Hong Kong between 24 + 0 to 33 + 6 weeks was performed from 1st October 2020 and 31st October 2021. Women with vaginal bleeding, ruptured membranes, and cervical dilation > 3 cm were excluded. The primary outcome was to test the characteristics of quantitative fFN in predicting spontaneous PTB < 37 weeks. Secondary outcome was to investigate the relationship between fFN value and time to PTB. Test characteristics of quantitative fFN at different thresholds were evaluated.Results48 women with TPTL were recruited. All had fFN testing at admission with the results being concealed from the obstetrician managing the patient. 10 mothers had PTB (< 37 weeks’ gestation). 7/48 (15%) had a subsequent PTB within 14 days from testing and 5 (10%) delivered within 48 h. The negative predictive value (NPV) of predicting delivery within 14 days was 97.3% and 100% when using a cut-off of < 50ng/ml and < 10ng/ml respectively. Using > 200 ng/ml as cut-off can also reliably predict delivery within 48 h – 7 days with positive predictive value PPV of 100%; as well as PTB before 37 weeks.ConclusionsQuantitative fFN has predictive value for spontaneous PTB prediction in symptomatic women in a Hong Kong population. fFN concentration could help clinicians rule out PTB and avoid unnecessary interventions and hospitalisation.

Value of cervical strain in ultrasound elastography as a predictor of spontaneous preterm delivery

BackgroundCervical incompetence is a failure of the cervix to retain the products of conception throughout pregnancy, which results into cervical dilatation and preterm delivery. Many methods are conducted for early detection of cervical shortening, ripening and eventually dilatation to lessen the incidence of the preterm delivery, which is responsible for about 75% of neonatal comorbidities. Ultrasound plays an important role in the diagnosis and early detection of cervical incompetence. Elastography is a relatively new technique, which investigates into another important factor for cervical insufficiency which is “tissue stiffness”. The process of early cervical ripening, which is an important and main step in spontaneous preterm delivery, precedes cervical shortening and renders the human cervix soft which can be diagnosed through the color-coding method of the sonoelastography technique. The aim of this study is to determine the value of cervical elastography as a predictor of spontaneous preterm labor and validate the role of strain ratio in such technique.ResultsIn our study, we examined the pregnant females by transvaginal conventional B-mode ultrasound and complementary elastography technique and recorded the elastography index of their cervix, internal os and external os together with measuring the amount of strain and strain ratio at internal and external os.ConclusionsWe concluded that women who had preterm delivery did have higher strain and elastography index as their cervices were softer than those who had full-term deliveries. Elastography therefore can be a reliable method for the prediction of preterm delivery.

Screening for spontaneous preterm birth by cervical length and shear-wave elastography in the first trimester of pregnancy

First-trimester cervical length for the prediction of spontaneous preterm delivery remains controversial. A better method for the measurement of the first-trimester cervical length and additional cervical ultrasound parameters for the identification of women at high risk for spontaneous preterm delivery are needed. This study aimed to compare the predictive value of cervical length measured by 2 different methods in the first trimester of pregnancy to predict spontaneous preterm delivery and to explore the potential value of first-trimester cervical shear-wave elastography for the prediction of spontaneous preterm delivery. This was a prospective study in unselected singleton pregnancies at 11+0 to 13+6 weeks' gestation. Cervical length was measured by the following 2 methods in the base-cohort population: (1) a linear distance between the 2 ends of the glandular area around the endocervical canal (single-line method: cervical length-s) and (2) a sum of the linear distance from the internal os to the greatest cervical curvature and the linear distance from this point to the external os (2-line method: cervical length-t). In a substudy, cervical shear-wave elastography scores for 9 regions of interest (inner, middle, and external parts of anterior lip, endocervical canal, and posterior lip) in midsagittal plane were also obtained by transvaginal ultrasonography. The screening performance of the first-trimester cervical length measured by the 2 different methods for the prediction of spontaneous preterm delivery was assessed by receiver operating characteristics curve analysis. The areas under the curves were compared using a DeLong test. The predictive performance of a soft cervix (mean elastography scores with multiple of median <5th, 10th, 15th, 20th, and 25th percentile) for spontaneous preterm delivery was also determined. Among a total of 2316 included pregnancies, spontaneous delivery at <37 and <34 weeks' gestation occurred in 111 cases (4.8%) and 20 cases (0.9%), respectively. In the total study population, when compared with the term delivery group, the median cervical length-t was shorter in women with spontaneous delivery at <34 weeks' gestation (36.9 mm vs 35.1 mm; P=.015), but there was no clear correlation for cervical length-s. Receiver operating characteristics curves demonstrated that cervical length-t achieved better performance in predicting spontaneous delivery at <34 weeks' gestation (area under the curve, 0.658 vs 0.573; P<.01) than cervical length-s. The best combined model to predict spontaneous delivery at <34 weeks' gestation was provided by cervical length-t and history of preterm delivery (area under the curve, 0.692). In the substudy, a soft cervix with a mean elastography scores multiple of median <10th percentile had a relative risk of 7.8 (95% confidence interval, 2.1-28.6) for spontaneous delivery at <34 weeks' gestation; the detection rate was 44.4% at a false-positive rate of 9.0%. The 2-line approach provides a better estimate of the actual first-trimester cervical length and achieves better performance as a screening tool for spontaneous preterm delivery at <34 weeks' gestation than the conventional measurement. A soft cervix as determined by shear-wave elastograpthy in the first trimester is associated with an increased risk for subsequent spontaneous preterm delivery.

Study protocol to quantify the genetic architecture of sonographic cervical length and its relationship to spontaneous preterm birth

IntroductionA short cervix (cervical length <25 mm) in the midtrimester (18–24 weeks) of pregnancy is a powerful predictor of spontaneous preterm delivery. Although the biological mechanisms of cervical change during...

The amniotic fluid cell-free transcriptome in spontaneous preterm labor

The amniotic fluid (AF) cell-free RNA was shown to reflect physiological and pathological processes in pregnancy, but its value in the prediction of spontaneous preterm delivery is unknown. Herein we profiled cell-free RNA in AF samples collected from women who underwent transabdominal amniocentesis after an episode of spontaneous preterm labor and subsequently delivered within 24 h (n = 10) or later (n = 28) in gestation. Expression of known placental single-cell RNA-Seq signatures was quantified in AF cell-free RNA and compared between the groups. Random forest models were applied to predict time-to-delivery after amniocentesis. There were 2385 genes differentially expressed in AF samples of women who delivered within 24 h of amniocentesis compared to gestational age-matched samples from women who delivered after 24 h of amniocentesis. Genes with cell-free RNA changes were associated with immune and inflammatory processes related to the onset of labor, and the expression of placental single-cell RNA-Seq signatures of immune cells was increased with imminent delivery. AF transcriptomic prediction models captured these effects and predicted delivery within 24 h of amniocentesis (AUROC = 0.81). These results may inform the development of biomarkers for spontaneous preterm birth.

Prediction of spontaneous preterm birth by cervical length in the first trimester of pregnancy: Comparison of two measurement methods.

Our objectives were to compare the single-line and two-line methods of cervical length measurement in the first trimester of pregnancy and to evaluate the potential value of the first trimester cervical length measured by the two methods in predicting spontaneous preterm birth. This was a prospective study in singleton pregnancies at 11+0 to 13+6 weeks of gestation. Cervical length was measured by two methods: (i) a linear distance between the two ends of the glandular area around the endocervical canal (single-line method) and (ii) a sum of a linear distance from the internal os to the greatest cervical curvature and a linear distance from this point of the cervix to the external os (two-line method). The screening performance of the first trimester cervical length measured by the two different methods for the prediction of spontaneous preterm delivery was assessed by receiver-operating characteristics (ROC) curve analysis. The areas under the ROC (AUROC) were compared by De Long test. A total of 1484 consecutive singleton pregnancies were included in this study. Spontaneous preterm delivery at <37and <32weeks occurred in 75 cases (5.1%) and 12 cases (0.8%), respectively. The median cervical length measured by the single-line method was significantly shorter than that by the two-line method (33.5vs 36.5mm, p<.001). Compared with the term delivery group, the median cervical length measured by the two-line method was shorter in women with spontaneous delivery at <32weeks of gestation (36.5vs 33.6mm, p<.01). No significant difference in the median cervical length measured by the single-line method was detected between the spontaneous preterm delivery and term delivery groups. Receiver-operating-characteristic curves demonstrated that cervical length measured by the two-line method achieved better performance in predicting spontaneous delivery at <32weeks compared with the single-line method (AUROC: 0.72 vs 0.61, p<.01). We have demonstrated that the first trimester cervical length, measured by the two-line approach, holds promise as a potential screening tool for early spontaneous preterm delivery.

ASSESSMENT OF CERVICAL LENGTH, SHAPE AND CONSISTENCY BETWEEN 18-24 WEEKS GESTATIONAL AGE BY TRANSVAGINAL ULTRASOUND FOR PREDICTION OF PRETERM LABOR

Background: Preterm labor is the presence of uterine contractions of sufficient frequency and intensity to affect progressive effacement and dilation of the cervix prior to term gestation. Shortening and funneling of the cervix was first described to be associated with the diagnosis of cervical incompetence, Transvaginal sonographic measurement of cervical length could be used to predict a risk for preterm delivery for a significant proportion of preterm births. Cervical length is measured by transvaginal ultrasound from internal os to external os while the urinary bladder is empty. Objective: To determine the value of measurement of cervical parameters by transvaginal ultrasound between 18 and 24 weeks' gestation in the prediction of spontaneous preterm delivery. Patients and Methods: The study was carried out at Bab EL-Sha'aria University Hospital between 1/10/2018 and 31/12/2019 on 200 primigravida women with single pregnancy and intact membranes. Women with scarred uterus, women with chronic medical diseases or obstetric problems, women who underwent cerclage and fetal anomalies were excluded from the study. For all participants, transvaginal ultrasound was done between 18 and 24 weeks' gestation for measurement of cervical length, shape and consistency. Results: Infant means weight at delivery was 1589 g with SD 215 in preterm delivery, while Infant mean weight at delivery was 3024 g with SD 200 which was significant. 33.3% of preterm birth delivered vaginally, while 66.7% delivered by C.S. 62.6% of full term delivery delivered vaginally, while 37.4% delivered by C.S. No statistically significant difference was found regarding mode of delivery. Cervical length was significant in prediction of preterm labor with sensitivity 88.9%, specificity 91.2%, PPV 50.0% and NPV 98.8 %. Cervical consistency index was significant in prediction of preterm labor with sensitivity 88.9%, Specificity 93.4%, PPV 57.1% and NPV 98.8 %. Funneling was present in 33.3% of preterm delivery, and 4.4% of full term delivery which was significant. Measurement of cervical length, shape and consistency was a reliable method for prediction of preterm labor. Conclusion: Measurement of cervical length, shape and consistency by transvaginal ultrasound between 18 and 24 weeks' gestation was a reliable method for prediction of preterm labor.

ASSESSMENT OF CERVICAL LENGTH, SHAPE AND CONSISTENCY BETWEEN 18-24 WEEKS GESTATIONAL AGE BY TRANSVAGINAL ULTRASOUND FOR PREDICTION OF PRETERM LABOR

Background: Preterm labor is the presence of uterine contractions of sufficient frequency and intensity to affect progressive effacement and dilation of the cervix prior to term gestation. Shortening and funneling of the cervix was first described to be associated with the diagnosis of cervical incompetence, Transvaginal sonographic measurement of cervical length could be used to predict a risk for preterm delivery for a significant proportion of preterm births. Cervical length is measured by transvaginal ultrasound from internal os to external os while the urinary bladder is empty. Objective: To determine the value of measurement of cervical parameters by transvaginal ultrasound between 18 and 24 weeks' gestation in the prediction of spontaneous preterm delivery. Patients and Methods: The study was carried out at Bab EL-Sha'aria University Hospital between 1/10/2018 and 31/12/2019 on 200 primigravida women with single pregnancy and intact membranes. Women with scarred uterus, women with chronic medical diseases or obstetric problems, women who underwent cerclage and fetal anomalies were excluded from the study. For all participants, transvaginal ultrasound was done between 18 and 24 weeks' gestation for measurement of cervical length, shape and consistency. Results: Infant means weight at delivery was 1589 g with SD 215 in preterm delivery, while Infant mean weight at delivery was 3024 g with SD 200 which was significant. 33.3% of preterm birth delivered vaginally, while 66.7% delivered by C.S. 62.6% of full term delivery delivered vaginally, while 37.4% delivered by C.S. No statistically significant difference was found regarding mode of delivery. Cervical length was significant in prediction of preterm labor with sensitivity 88.9%, specificity 91.2%, PPV 50.0% and NPV 98.8 %. Cervical consistency index was significant in prediction of preterm labor with sensitivity 88.9%, Specificity 93.4%, PPV 57.1% and NPV 98.8 %. Funneling was present in 33.3% of preterm delivery, and 4.4% of full term delivery which was significant. Measurement of cervical length, shape and consistency was a reliable method for prediction of preterm labor. Conclusion: Measurement of cervical length, shape and consistency by transvaginal ultrasound between 18 and 24 weeks' gestation was a reliable method for prediction of preterm labor.

A protein microarray analysis of amniotic fluid proteins for the prediction of spontaneous preterm delivery in women with preterm premature rupture of membranes at 23 to 30 weeks of gestation.

We sought to identify novel biomarkers in the amniotic fluid (AF) related to imminent spontaneous preterm delivery (SPTD) (≤ 14 days after sampling) in women with early preterm premature rupture of membranes (PPROM), using a protein microarray. This was a retrospective cohort study of a total of 88 singleton pregnant women with PPROM (23+0 to 30+6 weeks) who underwent amniocentesis. A nested case-control study for biomarker discovery was conducted using pooled AF samples from controls (non-imminent delivery, n = 15) and cases (imminent SPTD, n = 15), which were analyzed using an antibody microarray. Quantitative validation of four candidate proteins was performed, using ELISA, in the total cohort (n = 88). IL-8, MMP-9, and Fas levels were additionally measured for the comparison and to examine association of SPTD with the etiologic factors of PPROM. Of all the proteins studied in the protein microarray, four showed significant intergroup differences. Analyses of the total cohort by ELISA confirmed the significantly elevated concentrations of AF lipocalin-2, MMP-9, and S100 A8/A9, but not of endostatin and Fas, in women who delivered within 14 days of sampling. For inflammatory proteins showing a significant association, the odds of SPTD within 14 days increased significantly with an increase in baseline AF levels of the proteins (P for trend <0.05 for each) in each quartile, especially in the 3rd and 4th quartile. We identified several potential novel biomarkers (i.e., lipocalin-2, MMP-9, and S100 A8/A9) related to SPTD within 14 days of sampling, all of which are inflammation-related molecules. Furthermore, the SPTD risk increased with increasing quartiles of each of these inflammatory proteins, especially the 3rd and 4th quartile of each protein. The present findings may highlight the importance of inflammatory mechanisms and the degree of activated inflammatory response in developing SPTD in early PPROM.

Methods of detection and prevention of preterm labour and the PAMG-1 detection test: a review.

Preterm labour is the leading cause of hospitalization during pregnancy. In France, it results in more than 60,000 births before 37weeks of gestation every year. Recent studies suggest that detection of placental α-microglobulin-1 (PAMG-1) in vaginal secretions among women presenting symptoms of preterm labour with intact membranes has good predictive value for the onset of spontaneous preterm delivery within 7 days. The test is especially interesting, in that the repetition of antenatal corticosteroids for foetal lung maturation is no longer recommended in France and the effect of the initial administration is most beneficial in the 24h to 7 days afterwards. We included all studies listed in PubMed and clinicaltrials.gov with the terms "PAMG-1" and either "preterm labor" or "preterm labour", while excluding all studies on the subject of "rupture of the membranes" from 2000 through 2017. Ten studies were thus included. In women who had both the PAMG-1 and foetal fibronectin test, the PAMG-1 test was statistically superior to the measurement of cervical length for positive predictive value (p<0.0074), negative predictive value (p=0.0169) and specificity (p<0.001) for the prediction of spontaneous preterm delivery within 7 days. The use of PAMG-1 may make it possible to target the women at risk with a shortened cervix on ultrasound (<25mm) those with an imminent preterm delivery and therefore to adapt management, especially the administration of antenatal corticosteroid therapy.

VP52.26: Prediction of spontaneous preterm delivery in women with threatening preterm labour using elastography: a prospective study

VP52.26: Prediction of spontaneous preterm delivery in women with threatening preterm labour using elastography: a prospective study

Antenatal thymus volumes in fetuses that delivered

Infection and inflammation have been implicated in the etiology and subsequent morbidity associated with preterm birth. At present, there are no tests to assess for fetal compartment infection. The thymus, a gland integral in the fetal immune system, has been shown to involute in animal models of antenatal infection, but its response in human fetuses has not been studied. This study aims: (a) to generate magnetic resonance imaging (MRI) -derived fetal thymus volumes standardized for fetal weight; (b) to compare standardized thymus volumes from fetuses that delivered before 32weeks of gestation with fetuses that subsequently deliver at term; (c) to assess thymus size as a predictor of preterm birth; and (d) to correlate the presence of chorioamnionitis and funisitis at delivery with thymic volumes in utero in fetuses that subsequently deliver preterm. Women at high-risk of preterm birth at 20-32weeks of gestation were recruited. A control group was obtained from existing data sets acquired as part of three research studies. A fetal MRI was performed on a 1.5T or 3T MRI scanner: T2 weighted images were obtained of the entire uterine content and specifically the fetal thorax. A slice-to-volume registration method was used for reconstruction of three-dimensional images of the thorax. Thymus segmentations were performed manually. Body volumes were calculated by manual segmentation and thymus:body volume ratios were generated. Comparison of groups was performed using multiple regression analysis. Normal ranges were created for thymus volume and thymus:body volume ratios using the control data. Receiver operating curves (ROC) curves were generated for thymus:body volume ratio and gestation-adjusted thymus volume centiles as predictors of preterm birth. Placental histology was analyzed where available from pregnancies that delivered very preterm and the presence of chorioamnionitis/funisitis was noted. Normative ranges were created for thymus volume, and thymus volume was standardized for fetal size from fetuses that subsequently delivered at term, but were imaged at 20-32weeks of gestation. Image data sets from 16 women that delivered <32weeks of gestation (ten with ruptured membranes and six with intact membranes) and 80 control women that delivered >37weeks were included. Mean gestation at MRI of the study group was 28+4 weeks (SD 3.2) and for the control group was 25+5 weeks (SD 2.4). Both absolute fetal thymus volumes and thymus:body volume ratios were smaller in fetuses that delivered preterm (P<.001). Of the 16 fetuses that delivered preterm, 13 had placental histology, 11 had chorioamnionitis, and 9 had funisitis. The strongest predictors of prematurity were the thymus volume Z-score and thymus:body volume ratio Z-score (ROC areas 0.915 and 0.870, respectively). We have produced MRI-derived normal ranges for fetal thymus and thymus:body volume ratios between 20 and 32weeks of gestation. Fetuses that deliver very preterm had reduced thymus volumes when standardized for fetal size. A reduced thymus volume was also a predictor of spontaneous preterm delivery. Thymus volume may be a suitable marker of the fetal inflammatory response, although further work is needed to assess this, increasing the sample size to correlate the extent of chorioamnionitis with thymus size.

Maternal History and First Trimester Biochemical and Biophysical Markers in the Prediction of Spontaneous Preterm Delivery in Singleton Pregnancies

Maternal History and First Trimester Biochemical and Biophysical Markers in the Prediction of Spontaneous Preterm Delivery in Singleton Pregnancies

Evaluation of placental alpha microglobulin-1(PAMG1) accuracy for prediction of preterm delivery in women with the symptoms of spontaneous preterm labor; a comparison with cervical length and number of contractions

Introduction Since the capacity of tertiary centers is limited, identifying women with the risk of preterm delivery is crucial amongst women who refer to hospitals with threatened preterm labor. Objective The purpose of the present study was to evaluate the accuracy of the placental alpha microglobulin-1 (PAMG-1) test for identifying women who referred to hospitals with signs of spontaneous preterm labor and ultimately delivered within ≤48 h and ≤7 of testing and ≤37 weeks of gestation and its comparison with cervical length of <25 mm and number of contractions. Materials and methods A prospective observational study was performed on women with the signs of spontaneous preterm labor. Placental alpha microglobulin-1 (PAMG-1) was evaluated in vaginal secretion. Cervical length (CL) and number of contractions were evaluated and recorded. The test to- spontaneous- delivery interval was documented. Sensitivity (SN), specificity (SP), accuracy rate of the PAMG-1, cervical length of <25 mm and number of contractions in prediction of spontaneous preterm delivery within ≤48 h, ≤7 days and preterm delivery (≤37 weeks of gestation) were calculated. Results One hundred eighty women finished the study. 44 women had positive PAMG-1 test and 58 women had cervical length of <25 mm. Women with a positive PAMG-1 were more likely to deliver within ≤48 h (p < .0001), ≤7 days (p < .0001), and before 37 weeks (p < .0001), compared to the women who had a negative test. For delivery within ≤48 h, ≤7 days and ≤37 weeks, specificity (SP) of the PAMG-1; was statistically higher than cervical length of <25 mm and contractions of 12–17/hr but not contractions of ≥18/hr. PAMG-1 showed a higher accuracy rate than cervical length of <25 mm, contractions of 12–17/hr and contractions of ≥18/hr for deliveries within ≤48 h (78.9, 55.3, 48.9, and 69.44%, respectively) and ≤7 days (76.1, 55.32, 55, and 65.56%, respectively). For deliveries before 37 weeks; the PAMG-1 test showed higher LR + than CL of <25 mm, contractions of 12–17/hr and contractions of ≥18/hr [10.24 (2.57–40.86), 2.01 (1.24–3.23), 1.30 (1.05–1.62), and 5.12 (1.24–21.11), respectively]. PPV for deliveries within ≤48 h and ≤7 days for PAMG-1 was greater than cervical length of <25 mm and number of contractions, however, NPV did not show a significant difference. Conclusion PAMG-1 test showed a higher accuracy rate for prediction of delivery within ≤48 and ≤7 days in comparison with cervical length of <25 mm and number of contractions. Also, PAMG-1 test had a higher positive likelihood ratio for deliveries at ≤37 weeks. PPV for deliveries within ≤48 h and ≤7 days for PAMG-1 was greater than cervical length of <25 mm and number of contractions, however, NPV did not show a significant difference.

A Protein Microarray Analysis of Plasma Proteins for the Prediction of Spontaneous Preterm Delivery in Women with Preterm Labor.

We aimed to identify novel biomarkers in maternal plasma that predict spontaneous preterm delivery (SPTD) in women with preterm labor (PTL) using an antibody microarray and to develop the best prediction model for SPTD based on these biomarkers in combination with clinical and ultrasound factors. This retrospective cohort study included 215 women with singleton pregnancies and PTL (23-33weeks) who gave plasma samples. In a nested case-control study design, plasma proteomes from SPTD (case subjects, n = 15) and term delivery (control subjects, n = 15) groups were differentially profiled using a membrane-based antibody microarray. Six candidate biomarkers of interest were validated by enzyme-linked immunosorbent assay (ELISA) in the total cohort (n = 215). Cervical lengths were also measured. The primary outcome measure was SPTD within 48h after sampling. Twenty of the molecules studied displayed significant intergroup differences. Validation by ELISA confirmed significantly higher levels of plasma endostatin and lipopolysaccharide binding protein (LBP) in women who had SPTD within 48h than in those delivering after 48h. However, plasma macrophage inflammatory protein (MIP)-1α levels were significantly lower in women who delivered within 48h. A combined model was developed to predict SPTD within 48h using a stepwise regression procedure, which included plasma endostatin and LBP levels, nulliparity, and cervical length (area under the curve = 0.920). Plasma LBP, endostatin, and MIP-1α are potential new biomarkers for predicting imminent SPTD and a combined noninvasive model based on these biomarkers and clinical and ultrasound factors can accurately predict imminent SPTD in women with PTL.

OC09.03: Contribution of the amniocentesis for the ultrasound prediction of spontaneous preterm delivery in women with preterm labour

OC09.03: Contribution of the amniocentesis for the ultrasound prediction of spontaneous preterm delivery in women with preterm labour

Is Ultrasound Evaluation of the Cervical Stroma After Ultrasound-Indicated Cerclage Useful to Predict Outcomes? [33S

INTRODUCTION: We sought to assess if the evaluation of the cervical stroma before US-indicated cerclage placement contributes to the prediction of spontaneous preterm delivery (SPTD) <35 weeks. METHODS: Retrospective cohort study conducted at a single tertiary care institution. We collected information of women undergoing US-indicated cerclage from 2012 to 2017 who had transvaginal imaging of the cervix within 14 days before the procedure. We excluded cases of patients with other indications for cerclage, without cervical imaging before cerclage, Mullerian anomalies and multiple gestations. Measurement of the cervical length (CL) and stromal width of the posterior cervical lip were obtained. Our primary outcome was the rate of SPTD <35 weeks. Patients' consent and Institutional IRB approval were obtained. RESULTS: We analyzed outcomes of 110 patients who underwent US-indicated cerclage during the study period. The median gestational age at cerclage placement was 21 weeks. The median gestational age at delivery was 38 weeks. A total of 18/110 (19.8%) women delivered before 35 weeks. The median CL before cerclage for those who delivered <35 weeks was 13 mm compared to 17.4 mm for those delivering >35 weeks; P=0. 089. Meanwhile, the median cervical stroma in women delivering <35 weeks was 8.2 mm compared to 12.6 mm for those delivered >35 weeks; P=0.003 (after adjusting for confounders). CONCLUSION: Assessment of the cervical stroma is a useful predictor of SPTD <35 weeks in women who will undergo US-indicated cerclage. This technique is readily available and should be performed routinely in patients who will undergo US-indicated cerclage placement.

The diagnostic value of cervicovaginal and serum ferritin levels in relation to spontaneous preterm delivery

Objective The objective of the study was to detect the diagnostic value of cervicovaginal and serum ferritin levels in 20–24 weeks of gestation in the prediction of spontaneous preterm delivery in singleton pregnancies with no well-known risk factors of preterm delivery. Background Preterm delivery is one of the most important health problems in the world that may lead to severe short-term and long-term medical and developmental problems in infants. Patients and methods Venous blood and cervicovaginal fluid samples are drawn from 100 women with singleton pregnancies within 20–24 weeks of gestation at the Department of Obstetric and Gynecologies, El Mehalla Hospital and then they were followed up and the term of delivery were noted. Results Spontaneous preterm delivery in singleton pregnancies with no well-known risk factors is associated with increased levels of cervicovaginal and serum ferritin when measured within 20–24 weeks of gestation and there is a strong positive correlation between both serum and cervicovaginal ferritin levels measuring 0.83. However, the only significant predictor is serum ferritin as an increase by one unit of its value increases the preterm risk by 1.277. About 85% of preterm deliveries can be predicted by serum ferritin. Conclusion It has been observed that 20–24 weeks of gestation serum ferritin level is a significant predictor of preterm delivery in singleton normal pregnancies.

Prediction of spontaneous preterm delivery in women presenting with premature labor: a comparison of placenta alpha microglobulin-1, phosphorylated insulin-like growth factor binding protein-1, and cervical length

Placental alpha microglobulin-1 and phosphorylated insulin-like growth factor-binding protein-1 have been studied in patients at risk for preterm birth with signs and symptoms of preterm labor. However, a direct comparison between these 2 biomarkers, alone or in combination with cervical length measurement with an adequate sample size, has been lacking to date. The purpose of this study was to compare the placental alpha microglobulin-1 test and the phosphorylated insulin-like growth factor-binding protein-1 test alone and in combination with cervical length measurement for the prediction of imminent spontaneous preterm birth of testing in pregnant women with symptoms of preterm labor in a tertiary care setting. Four hundred three patients with intact amniotic membranes and cervical dilation ≤3 cm, without recent intercourse or cerclage, between gestational weeks of 20+0 and 36+6 were recruited prospectively from 3 international centers. Placental alpha microglobulin-1 and phosphorylated insulin-like growth factor-binding protein-1 tests were conducted before cervical length measurement via transvaginal ultrasound scanning. Caregivers were blinded to the biomarker test results. Medically indicated deliveries within 14 days of testing were excluded. Standard performance statistics with 95% confidence intervals were calculated and compared based on pairwise estimates from a generalized model. Of 403 subjects who were enrolled in the study cohort, 94% (383/403 women) met the inclusion criteria. Median gestational age and cervical length at presentation were 30+5 weeks and 27 mm, respectively; 6.8% women (26/383 women) had spontaneous birth ≤7 days from testing. The placental alpha microglobulin-1 test was positive in 7.8% of the women (30/383 women); the phosphorylated insulin-like growth factor-binding protein-1 test was positive in 29.5% women (113/383 women). Positive predictive value for placental alpha microglobulin-1, phosphorylated insulin-like growth factor-binding protein-1, and cervical length <25 mm for the prediction of spontaneous preterm birth in the overall cohort was 60.0% (18/30 women), 18.6% (21/113 women), 11.8% (18/152 women), respectively. The negative predictive value was 97.7% (345/353 women), 98.2% (265/270 women), 96.5% (223/231 women), respectively. The prevalence of spontaneous preterm birth in this group was 6.8% (26/383 women). The positive likelihood ratios were 20.6, 3.1, and 1.8, respectively. The negative likelihood ratio were 0.3, 0.3, and 0.5, respectively. Positive predictive values for placental alpha microglobulin-1 and phosphorylated insulin-like growth factor-binding protein-1 tests in patients with cervical length shortening of 15-30 mm for the prediction of spontaneous preterm birth were 60.9% (14/23 women) and 28.1% (16/57 women), respectively. The negative predictive values were 97.1% (168/173 women) and 97.8% (136/139 women), respectively. The prevalence of spontaneous preterm birth in the 15-30 mm cohort was 9.7% (19/196 women). The positive likelihood ratios were 14.5 and 3.6, respectively. The negative likelihood ratios were 0.3 and 0.2, respectively. Placental alpha microglobulin-1 is significantly more specific than phosphorylated insulin-like growth factor-binding protein-1 for the prediction of spontaneous preterm birth ≤7 days (P<.0001), whereas both tests have comparable sensitivity. In patients with cervical length 15-30 mm, although placental alpha microglobulin-1 has a significantly higher positive predictive value and specificity compared with phosphorylated insulin-like growth factor-binding protein-1 for the prediction of spontaneous preterm birth at ≤7 days (P<.01), both tests have a comparable sensitivity and negative predictive value. In conclusion, placental alpha microglobulin-1 is a better predictor of imminent spontaneous preterm birth when compared with phosphorylated insulin-like growth factor-binding protein-1 alone or in combination with cervical length measurement. In patients with shortening of cervical length of 15-30 mm, the placental alpha microglobulin-1 test is a significantly better predictor of imminent spontaneous preterm birth within 7 days of testing than is phosphorylated insulin-like growth factor-binding protein-1.