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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, M.J.M.C. / Kurjak M.D., Asim / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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The value of quantitative ultrasound tissue characterization of the cervix and rapid fetal fibronectin in predicting preterm delivery

Ismail Tekesin1 / Diethelm Wallwiener2 / Stephan Schmidt3

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Corresponding author: Ismail Tekesin, MD Department of Gynecology and Obstetrics University of Tuebingen Calwerstrasse 7 D-72076 Tübingen Germany Tel.: 49-7071-2982211 Fax: 49-7071-295619

Citation Information: Journal of Perinatal Medicine. Volume 33, Issue 5, Pages 383–391, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2005.070, September 2005

Publication History

Received:
February 15, 2005
Revised:
May 21, 2005
Accepted:
May 24, 2005
Published Online:
2005-09-13

Abstract

Objective: To evaluate clinical risk factors, cervical fetal fibronectin (fFN), cervical length, and mean gray value assessment in predicting of preterm delivery (PTD) in patients with signs and/or symptoms of preterm labor (PTL).

Study design: One hundred and seventeen women with PTL between 24 and 34 weeks of gestation were included. Cervical swabs were tested for fFN using the rapid fFN assay. When 2-dimensional transvaginal ultrasound measurement of cervical length was completed, a region of interest (ROI) of constant size was defined in the midsection of the posterior wall, and the tissue-specific gray scale was determined. The end point were PTDs at <34 and <37 weeks of gestation.

Results: In univariate analysis, the three strongest predictors of spontaneous preterm birth <34 weeks were positive fFN (relative risk [RR] 8.9; 95% confidence interval [CI] 2.6–30.1), cervical length ≤2.5 cm (RR 6.9; 95% CI 1.6–29.7), and a low mean gray value of ≤5.97 (RR 7.9; 95% CI 2.3–27.2). Predictors significantly associated with spontaneous PTD at less than 37 weeks of gestation included previous PTD in multiparas (RR 3.9; 95% CI 1.6–9.5), positive fFN (RR 7.6; 95% CI 3.8–15.3), cervical length ≤2.5 cm (RR 2.6; 95% CI 1.4–5.1) and a low gray scale value of ≤6.54 (RR 4.5; 95% CI 2.3–8.9). In the final regression models used to predict spontaneous PTD <34 weeks and <37 weeks of gestation, both a positive fetal fibronectin (odds ratio [OR] 13.4; 95% CI, 2.5–72.1, P=0.003 vs. OR, 17.3; 95% CI 4.9–61.8, P<0.001) and a low gray scale value (OR 6.3 95% CI 1.3–29.4, P=0.02 vs. OR, 7.1; 95% CI 2–25.2, P=0.003) remained powerful predictors. The RRs of spontaneous PTD <37 weeks has been analyzed by a combination of these significant parameters. Low mean gray value ≤6.54 and negative fFN had a 10.3-fold (95% CI 2–74.5) increased risk of spontaneous preterm birth at <37 weeks. Combination of positive fFN and normal gray level (>6.54), had a higher increase risk of PTD (RR 18.1; 95% CI 4.4–76.7). When both factors were positive, the RR increases to 24.8 (95% CI 6.2–98.7).

Conclusions: Combined use of rapid fFN and cervical gray value analysis improves the diagnostic efficiency and allows identification of women at risk for preterm delivery and in need for further prophylactic/therapeutic intervention.

Keywords: Cervical length; fetal fibronectin; preterm delivery; quantitative ultrasonic tissue characterization

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