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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica

IMPACT FACTOR 2018: 1.361
5-year IMPACT FACTOR: 1.578

CiteScore 2018: 1.29

SCImago Journal Rank (SJR) 2018: 0.522
Source Normalized Impact per Paper (SNIP) 2018: 0.602

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Volume 33, Issue 5


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

Ismail Tekesin / Diethelm Wallwiener / Stephan Schmidt
Published Online: 2005-09-13 | DOI: https://doi.org/10.1515/JPM.2005.070


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

About the article

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

Received: February 15, 2005

Revised: May 21, 2005

Accepted: May 24, 2005

Published Online: 2005-09-13

Published in Print: 2005-10-01

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

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