The predictive value of cervical biometry and placental alpha-microglobulin 1 in cervicovaginal fluid in preterm labor

Abstract

Objective To determine the benefit of assessment of cervicovaginal placental alpha-microglobulin 1 (PAMG-1) with the cervical biometry in prediction of preterm labor (PTL). Background Many screening methods are now used for the diagnosis of PTL. Short cervix in the second trimester, detected by transvaginal ultrasound, was significantly related to PTL. The presence of PAMG-1 in cervicovaginal discharge of women with clinically intact membranes is indicative of imminent delivery. Patients and methods This prospective longitudinal study was conducted on 90 pregnant women and divided into two equal groups: group A included 45 pregnant women between 24+0 and 36+6 weeks with threatened PTL and short cervix, and group B included 45 pregnant women at the same age group without threatened PTL symptoms and with normal cervical biometry. Results Women of preterm group had statistically significant shorter cervical length (15.6% <15 mm, 48.9% between 15 and 20 mm, and 35.6% between 20 and 24 mm; P ≤ 0.001) and more detectable positive cervicovaginal fluid PAMG-1 (32 vs. 0; P < 0.001). Cervical PAMG-1 had a sensitivity of 71.11%, a specificity of 100.0%, a positive predictive value of 100%, a negative predictive value of 77.59, and an accuracy of 85.56%. Moreover, there was a strong correlation between positive PAMG and time of delivery, as 18.8% gave birth in first 48 h, 50.0% gave birth between 2 and 7 days, and 31.3% gave birth after 7 days. On the contrary, all women with negative PAMG gave birth after 7 days. Conclusions Regular use of the two tests described could help identify low-risk patients and lower the number of unnecessary hospitalizations and treatments.