Predicting preterm delivery in asymptomatic pregnant women with prior preterm delivery by measurement of cervical length, fetal fibronectin and phosphorylated insulin-like growth factor-binding protein-1

To evaluate the accuracy of cervical length measurement in combination with assessment of fetal fibronectin [FFN] and phosphorylated insulin-like growth factor-binding protein-1 [phIGFBP-1] in cervico-vaginal secretions as a predictor of preterm delivery in asymptomatic pregnant women with a history of preterm birth. 91 singleton pregnant mothers [between 22-24 weeks of gestation] with previous history of one or more unexplained preterm birth were included in the study. For all participants transvaginal sonographic measurement of cervical length was carried out together with qualitative assay of fetal fibronectin and quantitative measurement of phosphorylated insulin-like growth factor binding protein-1 in cervico-vaginal secretions. The primary outcome of the study was delivery before completed 37 weeks of gestation. There was a significant association between cervical length and the occurrence of preterm delivery [p=0.002], cervical length was 23.12 +/- 8.5mm in 33 cases who experienced preterm delivery compared to 29.34 +/- 9.4mm in 58 cases who delivered at term. Regarding fetal fibronectin assay in cervico-vaginal secretions, no statistically significant difference was found between those who delivered preterm and those who had term delivery [p=0.972]. Measurement of phosphorylated insulin-like growth factor-binding protein-1 [phIGFBP-1] in cervico-vaginal secretions showed statistically significant difference among patients who delivered preterm compared to those who did not [p=0.007]. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for cervical length, phIGFBP-1, and for their combination, and our results demonstrated high sensitivity, specificity, positive and negative predictive values for the combined method compared with either method alone. Both cervical length and phIGFBP-1 measurement in cervico-vaginal secretions at 22-24 weeks are likely to be useful in predicting preterm delivery in asymptomatic women with a history of preterm birth and their combination increased their sensitivity, specificity, positive and negative predictive values as predictors

significance of human beta-HCG and vaginal cervicometry in predicting preterm delivery

The aim of the present study was to determine, in addition to endovaginal cervicometry, whether hCG detected in cervicovaginal secretions of patients at 28-34 weeks' gestation with signs and symptoms of preterm labor is a predictor for preterm birth [-37 weeks' gestation]. A prospective observational study of pregnant women with threatened preterm labor between 28 and 34 weeks gestation. The study population consisted of patients admitted to the causality unit in the Department of Obstetrics and Gynecology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt between December 2004 to January 2006 with signs and symptoms suggestive of preterm labor and intact membranes. One hundred and three patients satisfied the inclusion criteria and were screened with a bedside qualitative hCG assay and transvaginal cervicometry and subsequently with a quantitative hCG assay. Then, digital examination of the cervix was performed and Bishop scores were assessed. All samples were obtained prior to the administration of tocolytic therapy, refrigerated at -20°C, and assayed within 72 hrs. The primary outcome of the study was the success of stopping labor for at least 72 hours after stopping of tocolytic drug. Qualitative and quantitative hCG results were obtained for all patients enrolled. The mean gestational age at sampling was 31.1 weeks; combined qualitative hCG and cervical length revealed sensitivity and specificity of 91.67%, 84.81% respectively and combined quantitative hCG with cervical length revealed sensitivity and specificity of 91.67%, 86.08% respectively. Qualitative measurements of hCG concentration from cervicovaginal secretions does not require additional instruments and may be easily and cheaply performed at the bedside. Transvaginal ultrasound cervical measurement is a safe and effective technique to predict increased risk of preterm delivery in selected patients and normal results can help avoid unnecessary interventions, Combining the qualitative hCG testing with cervical length will get benefit of the higher sensitivity of the cervical length and the higher specificity of hCG testing in accurately predicting pre-term labor