Cervical length and phosphorilated insulin like growth factor binding protein-1 as the predictors of spontaneus preterm delivery in symptomatic women

Abstract

Brief Introduction: Preterm delivery is the leading cause of neonatal mortality and morbidity. Consequently, women presenting with threatened preterm labor are often treated with hospitalization and the administration of tocolytics to avoid preterm delivery. Randomized studies on the use of tocolytics in threatened preterm labor have demonstrated a significant prolongation of pregnancy by about 7 days but no significant reduction in the incidence of preterm delivery, perinatal morbidity or mortality. Objective: To assess the combined use of cervical length and cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in the prediction of preterm delivery in symptomatic women in next 14 days Materials & Methods: 58 pregnant women were eligible to join the study if they attended the University Clinic for Gynecology and Obstetrics, Skopje and were admitted to Department of High Risk pregnancy Unit with symptoms of preterm labor (symptoms of uterine activity judged by the assessing physician to be indicative of preterm labor) at 24 to 36 weeks gestation. They were recruited in period of 6 months from September 2013 till March 2014 Clinical Cases or Summary Results: Some recent studies evaluated a combination of cervical length and phIGFBP-1 in the prediction of preterm delivery in symptomatic women. Eroglu et al. assessed 51 cases between 24 and 35 weeks of gestation. These authors reported an increase in specificity and positive predictive value by combining phIGFBP-1 with cervical length. PhIGFBP alone is not a good predictor for delivering in next 14 days but combination of cervical length(≤15 mm, ≤25mm) with phIGFBP is a good predictor. It means that probability for delivery in the following 14 days in patients with positive phIGFBP and cervical length ≤15 mm is 0.88 or probability for not delivering in those patients is 0.12.In 88% patients with positive phIGFBP and cervical length ≤15 mm will deliver in the following 14 days. Conclusions: Finally, testing the value of the combination of phIGFBP- 1 and cervical length allow us to find prediction model based on logistic regression analysis. Again, our study population was too small to allow such an approach. However, the combined use of phIGFBP-1 and cervical length with symptomatic women might have the potential for decreasing the false positive diagnoses of impending preterm delivery, allowing therefore to reduce the biological and economic costs of inappropriate treatment. Other demographic data (history of previous preterm delivery, history of spontaneous abortion, parity, BMI, Orthodox or Muslims, vaginal Ph) are not good predictors for delivery in the following 14 days. (Table Presented).