Role of cervical length and placental alpha microglobulin-1 to predict preterm birth

Abstract

Introduction

Preterm labor is the leading cause of premature mortality and morbidity. Therefore, to rule-in and rule-out preterm delivery is a very important issue in our clinical practice.

Objective

The aim of this study was to investigate the value of placental alpha microglobulin-1 (PAMG-1) molecule positivity in cervicovaginal secretions of women who have a CL <25 mm and presenting with preterm labor symptoms to predict spontaneous preterm birth within seven days.

Materials and methods

This was a prospective cohort study conducted in Ankara University Department of Obstetrics and Gynecology between August 2017 and February 2019 on the patients who had Preterm labor symptoms, <25 mm transvaginal cervical length (CL), clinically intact membranes. The primary outcome of the study was the power of CL and PAMG-1 positivity on the prediction of preterm birth in seven days.

Results

Sensitivity and specificity values of PAMG-1 in our study population to predict spontaneous preterm birth in seven days were calculated 52.94% and 98.84%, respectively, negative predictive value (NPV) and positive predictive value (PPV) were calculated 91.4% and 90%, respectively. When we investigated our data according to different CL cutoffs, sensitivity and NPV for 20 mm cutoff were 88.24% and 96.3% that was better than PAMG-1, but specificity and PPV were 60.47% and 30.61%, respectively, that was more ineffective than PAMG-1. If we calculate the values according to 15 mm and 10 mm CL cutoffs sensitivity values were 58.8% and 23.53%, specificity values were 81.4% and 91.86%, NPV were 90.9% and 85.87%, PPV were 38.46% and 36.36%, respectively. Finally, accuracy value of PAMG-1 to predict spontaneous preterm birth in seven days was 91.26% that was better than other CL cutoffs (20 mm, 15 mm, and 10 mm).

Conclusion

PAMG-1 molecule with high NPV and PPV (91.4% and 90%) combination will contribute our clinical decision on the population who had preterm labor symptoms and a CL shorter than 25 mm.

Keywords:

• Preterm birth
• placental alpha microglobulin-1
• cervical length
• prediction
• preterm labor

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study has been funded by “Ankara University Scientific Research Projects Commission” with “17L0230015” Project Number.