FETAL FIBRONECTIN AND PHOSPHORILATED INSULIN- LIKE GROWTH FACTOR BINDING PROTEIN-1 AS PREDICTORS OF SPONTANEUS PRETERM DELIVERY

Abstract

The aim of the paper was to assess the combined use of cervical length, fetal fibronectin and cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in the prediction of preterm delivery in symptomatic women in the following 14 days. Cervical length was prospectively measured in 58 consecutive singleton pregnancies with intact membranes and regular contractions at 24–36 weeks; fetal fibronectin and phIGFBP-1 were also assessed. Demographic data was evaluated (history of previous preterm delivery, history of spontaneous abortion, parity, BMI, maternal age, Islamic or Orthodox religion). Values of all variables were evaluated (demographic data, cervical length and values of phIGFBP1 and fetal fibronectin) alone and in combination with cervical length of ≤ 15mm and more than 15 mm. PhIGFPB was positive in 30 patients (22 of them gave birth in 14 days). In women with cervical length less than 15 mm phIGFBP-1, it was positive in 9 pregnant women who were delivered in 14 days. In women with cervical length less than 25 mm phIGFBP-1 was positive in 26 patients (2 of them gave birth in 14 days). In patients with cervical length more than 25 mm phIGFBP-1 was positive in 4 patients (2 of them gave birth in 14 days). Using logistic regression we confirmed that with OR 0.117 and CI 95% (0.046-0.295) and p<0.01 odds for preterm birth among patients with negative test results, phIGFBP-1 was by 0.117 lower than the odds for preterm birth among patients with positive test results. Using the same test, we confirmed that with OR=14,722 (CI 95% 5.27-41.1), (p<0.01) cervical length less than 25 mm was a good predictor of preterm delivery in symptomatic patients. Probability for delivery in the following 14 days in patients with positive phIGFBP-1 and cervical length≤15 mm is 0.88 or probability for not delivering in those patients is 0.12. Eighty-eight percents of patients with positive phIGFBP-1 and cervical length ≤15 mm will give birth in the following 14 days. In symptomatic women phIGFBP-1 may significantly improve the risk assessment for preterm delivery with cervical length and help to plan subsequent pregnancy management.

Keywords

• preterm labor
• transvaginal ultrasound
• phIGFBP-1
• fetal fibronectin
• sensitivity