| Popis: |
Preterm birth is the leading cause of perinatal morbidity and mortality. It is of great clinical importance to find markers that could help in identifying women with threatened pre-term labor who have the highest risk of pre-term delivery and who might benefit from timely admission. The objective of the present study was to evaluate the use of cervical phosphorylated insulin-like growth factor-binding protein 1 (phIGFBP-1) in the prediction of pre-term delivery and to assess its association with cervical length measured by trans vaginal sonography (TVS), as a predictive diagnostic test. We enrolled 100 women between 20 and 35 weeks of gestation. Fifty subjects who had presented with symptoms of pre-term labor were recruited as Group A and another 50 with risk factors for pre-term birth but with no symptoms at the time of presentation as Group B. All the participants were subjected to cervical length measurement and rapid bed side test to detect phIGFBP-1 in cervicovaginal secretions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both tests were calculated and compared in terms of period of gestation at delivery and time lapse between test and delivery. Qualitative data were analyzed by using Chi-square test and Fisher's exact test, whereas quantitative data were analyzed by using unpaired Student's t test and Mann-Whitney test. P value In the symptomatic group, sensitivity, specificity, PPV, and NPV of phIGFBP-1 in predicting delivery within 48 h, 7 days, 14 days, and preterm delivery (≤37 weeks) was 100%, 100%, 100%, and 76% (sensitivity), 52.6%, 60.6%, 62.5%, and 56% (specificity), 40%, 56.7%, 60%, and 63% (PPV) 100%, 100%, 100%, and 70% (NPV), respectively. Sensitivity, specificity, PPV, and NPV of cervical length in predicting pre-term delivery in symptomatic group was 20%, 96%, 83.3%, and 54.5%, respectively. In the asymptomatic group, sensitivity, specificity, PPV, and NPV of phIGFBP-1 in predicting pre-term delivery was 0%, 87.5%, 0%, and 77.8% and that of cervical length was 0%, 95%, 0%, and 79.2%, respectively. The results of the present study suggest that phIGFBP-1 has high NPV for prediction of pre-term labor. Pre-term birth is very unlikely if the results of both tests, that is, phIGFBP-1 and cervical measurements are negative and therefore it could be of value in reduction of maternal morbidity by preventing unnecessary interventions. |
