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Published in: Archives of Gynecology and Obstetrics 4/2009

01-10-2009 | Original Article

Cervicovaginal HCG and cervical length for prediction of preterm delivery in asymptomatic women at high risk for preterm delivery

Authors: Kaliprasad Adhikari, Rashmi Bagga, Vanita Suri, Sunil Arora, Shet Masih

Published in: Archives of Gynecology and Obstetrics | Issue 4/2009

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Abstract

Objective

To predict the risk of preterm birth (<37 weeks) or early preterm birth (<34 weeks) by cervicovaginal HCG and cervical length measured between 24–28 weeks of gestation in asymptomatic women at high risk for preterm birth.

Methods

This study was conducted in the departments’ of Obstetrics & Gynaecology and Immunopathology of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. In 75 pregnant women at high risk for preterm birth because of prior one on more preterm births due to spontaneous labour or ruptured membranes, cervicovaginal HCG and cervical length (by TVS) were measured between 24–28 weeks of gestation. These parameters were correlated individually and in combination for prediction of preterm birth.

Results

Of the 75 women, 20 (26.7%) delivered <37 weeks and 6 (8%) delivered <34 weeks. To predict delivery <37 weeks, cervical length <2.95 cm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 75%, 80.1%, 71.4% and 90.7% respectively, and cervicovaginal HCG >4.75 mIU/ml had a sensitivity, specificity, PPV, and NPV of 70%, 61.81%, 40% and 85% respectively. To predict delivery <34 weeks, cervical length <2.65 cm had a sensitivity, specificity, PPV, and NPV of 50%, 85.50%, 23.08% and 95.16% respectively; and cervicovaginal HCG >14 mIU/ml had a sensitivity, specificity, PPV and NPV of 83.3%, 85.5%, 33.3% and 98.3% respectively. Cervical length was superior to predict delivery <37 weeks, whereas HCG was superior to predict delivery <34 weeks. Their combination was superior to predict preterm birth both <37 weeks or <34 weeks, than either parameter used alone.

Conclusion

In high risk asymptomatic women, increased cervicovaginal HCG and reduced cervical length and between 24 to 28 weeks of gestation increased the risk of preterm delivery.
Literature
2.
go back to reference Creasy RK (1993) Preterm birth prevention: where are we? Am J Obstet Gynecol 168:1223–1230PubMed Creasy RK (1993) Preterm birth prevention: where are we? Am J Obstet Gynecol 168:1223–1230PubMed
3.
go back to reference Mercer BM, Goldenberg RL, Moawad AH, Meis PJ, lams JD, Das AF, Caritis SN, Miodovnik M, Menard K, Thurnau GR, Dombrowski MP, Roberts JM, McNellis D (1999) The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. Am J Obstet Gynecol 181:1216–1221. doi:10.1016/S0002-9378(99)70111-0 PubMedCrossRef Mercer BM, Goldenberg RL, Moawad AH, Meis PJ, lams JD, Das AF, Caritis SN, Miodovnik M, Menard K, Thurnau GR, Dombrowski MP, Roberts JM, McNellis D (1999) The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. Am J Obstet Gynecol 181:1216–1221. doi:10.​1016/​S0002-9378(99)70111-0 PubMedCrossRef
5.
go back to reference Sanchez-Ramos L, Kaunitz AM, Delke I (2005) Progestational agents to prevent preterm birth. Obstet Gynecol 105:273–279PubMed Sanchez-Ramos L, Kaunitz AM, Delke I (2005) Progestational agents to prevent preterm birth. Obstet Gynecol 105:273–279PubMed
6.
go back to reference Goldenberg RL, Iams JD, Mercer BM, Meis PJ, Maowad AH, Copper RL, Das A, Thom E, Johnson F, McNellis D, Miodovnik M, Van Dorsten JP, Caritis SN, Thurnau GR, Bottoms SF, MEMU the NICHD Network (1998) The preterm prediction study: the value of new vs. standard risk factors predicting early and all spontaneous preterm birth. Am J Public Health 88:223–238. doi:10.2105/AJPH.88.2.233 CrossRef Goldenberg RL, Iams JD, Mercer BM, Meis PJ, Maowad AH, Copper RL, Das A, Thom E, Johnson F, McNellis D, Miodovnik M, Van Dorsten JP, Caritis SN, Thurnau GR, Bottoms SF, MEMU the NICHD Network (1998) The preterm prediction study: the value of new vs. standard risk factors predicting early and all spontaneous preterm birth. Am J Public Health 88:223–238. doi:10.​2105/​AJPH.​88.​2.​233 CrossRef
7.
go back to reference Moutquin JM (2003) Classification and heterogeneity of preterm birth. BJOG 110(Suppl 20):30–33PubMed Moutquin JM (2003) Classification and heterogeneity of preterm birth. BJOG 110(Suppl 20):30–33PubMed
8.
go back to reference Goldenberg RL, Iams JD, Mercer BM, Meis PJ, Maowad AH, Copper RL, Das A, Miodovnik M, Van Dorsten JP, Caritis SN, Thurnau GR, Dombrowski MP (2001) The preterm prediction study; towards a multiple marker test for prediction of spontaneous preterm birth. Am J Obstet Gynecol 185:643–645. doi:10.1067/mob.2001.116752 PubMedCrossRef Goldenberg RL, Iams JD, Mercer BM, Meis PJ, Maowad AH, Copper RL, Das A, Miodovnik M, Van Dorsten JP, Caritis SN, Thurnau GR, Dombrowski MP (2001) The preterm prediction study; towards a multiple marker test for prediction of spontaneous preterm birth. Am J Obstet Gynecol 185:643–645. doi:10.​1067/​mob.​2001.​116752 PubMedCrossRef
9.
go back to reference Bernstein PS, Stern R, Lin N, Furgiuele J, Karmen A, Comerford-Freda M, Chazotte C (1998) Beta-human chorionic gonadotropin in cervicovaginal secretions as a predictor of preterm delivery. Am J Obstet Gynecol 179:870–873. doi:10.1016/S0002-9378(98)70180-2 PubMedCrossRef Bernstein PS, Stern R, Lin N, Furgiuele J, Karmen A, Comerford-Freda M, Chazotte C (1998) Beta-human chorionic gonadotropin in cervicovaginal secretions as a predictor of preterm delivery. Am J Obstet Gynecol 179:870–873. doi:10.​1016/​S0002-9378(98)70180-2 PubMedCrossRef
12.
go back to reference Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, Thom E, McNellis D, Copper R, Johnson F, Roberts JM, the National Institute of Child Health, human Development Maternal Fetal Medicine Unit Network (1996) The length of cervix and the risk of spontaneous premature delivery. N Engl J Med 334:567–572. doi:10.1056/NEJM199602293340904 PubMedCrossRef Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, Thom E, McNellis D, Copper R, Johnson F, Roberts JM, the National Institute of Child Health, human Development Maternal Fetal Medicine Unit Network (1996) The length of cervix and the risk of spontaneous premature delivery. N Engl J Med 334:567–572. doi:10.​1056/​NEJM199602293340​904 PubMedCrossRef
13.
go back to reference Rizzo G, Capponi A, Arduini D, Lorido C, Romanini C (1996) The value of fetal fibronectin in cervical and vaginal secretions and of ultrasonographic examination of uterine cervix in predicting premature delivery of patients with preterm labour and intact membranes. Am J Obstet Gynecol 175:1146–1151. doi:10.1016/S0002-9378(96)70020-0 PubMedCrossRef Rizzo G, Capponi A, Arduini D, Lorido C, Romanini C (1996) The value of fetal fibronectin in cervical and vaginal secretions and of ultrasonographic examination of uterine cervix in predicting premature delivery of patients with preterm labour and intact membranes. Am J Obstet Gynecol 175:1146–1151. doi:10.​1016/​S0002-9378(96)70020-0 PubMedCrossRef
16.
17.
go back to reference To MS, Skentou CA, Royston P, Yu CK, Nicolaides KH (2006) Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population based prospective study. Ultrasound Obstet Gynecol 27:362–367. doi:10.1002/uog.2773 PubMedCrossRef To MS, Skentou CA, Royston P, Yu CK, Nicolaides KH (2006) Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population based prospective study. Ultrasound Obstet Gynecol 27:362–367. doi:10.​1002/​uog.​2773 PubMedCrossRef
18.
go back to reference Owen J, Yost N, Berghella V, Thom E, Swain M, Dildy GA III, Miodovnik M, Langer O, Sibai B, McNellis D, National Institute of Child Health, Human Development, Maternal-Fetal Medicine Units Network (2001) Mid trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA 286:1340–1348. doi:10.1001/jama.286.11.1340 PubMedCrossRef Owen J, Yost N, Berghella V, Thom E, Swain M, Dildy GA III, Miodovnik M, Langer O, Sibai B, McNellis D, National Institute of Child Health, Human Development, Maternal-Fetal Medicine Units Network (2001) Mid trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA 286:1340–1348. doi:10.​1001/​jama.​286.​11.​1340 PubMedCrossRef
19.
go back to reference Tsoi E, Fuchs IB, Rane S, Geerts L, Nicolaides KH (2005) Sonographic measurement of cervical length in threatened preterm labour in singleton pregnancies with intact membranes. Ultrasound Obstet Gynecol 25:353–356. doi:10.1002/uog.1809 PubMedCrossRef Tsoi E, Fuchs IB, Rane S, Geerts L, Nicolaides KH (2005) Sonographic measurement of cervical length in threatened preterm labour in singleton pregnancies with intact membranes. Ultrasound Obstet Gynecol 25:353–356. doi:10.​1002/​uog.​1809 PubMedCrossRef
20.
go back to reference Botsis D, Papagianni V, Vitoratos N, Makraakis E, Anavantinos L, Creatasas G (2005) Prediction of preterm delivery by sonographic estimation of cervical length. Biol Neonate 88:42–45. doi:10.1159/000084457 PubMedCrossRef Botsis D, Papagianni V, Vitoratos N, Makraakis E, Anavantinos L, Creatasas G (2005) Prediction of preterm delivery by sonographic estimation of cervical length. Biol Neonate 88:42–45. doi:10.​1159/​000084457 PubMedCrossRef
21.
go back to reference Crane JM, Hutchens D (2008) Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk. Ultrasound Obstet Gynecol 31:579–587. doi:10.1002/uog.5323 PubMedCrossRef Crane JM, Hutchens D (2008) Transvaginal sonographic measurement of cervical length to predict preterm birth in asymptomatic women at increased risk. Ultrasound Obstet Gynecol 31:579–587. doi:10.​1002/​uog.​5323 PubMedCrossRef
22.
go back to reference Kletzky OA, Rossman F, Bertolli SI, Platt LD, Mishell DR (1985) Dyanmics of human chorionic gonadotropin, prolactin, and growth hormone in serum and amniotic fluid throughout normal human pregnancy. Am J Obstet Gynecol 151:878–884PubMed Kletzky OA, Rossman F, Bertolli SI, Platt LD, Mishell DR (1985) Dyanmics of human chorionic gonadotropin, prolactin, and growth hormone in serum and amniotic fluid throughout normal human pregnancy. Am J Obstet Gynecol 151:878–884PubMed
25.
go back to reference Sanchez-Ramos L, Mentel C, Bertholf R, Kauntiz AM, Delke I, Loge C (2003) Human chorionic gonadotropin in cervicovaginal secretions as a predictor of preterm delivery. Int J Gynecol Obstet (Paris) 83:151–157. doi:10.1016/S0020-7292(03)00273-x CrossRef Sanchez-Ramos L, Mentel C, Bertholf R, Kauntiz AM, Delke I, Loge C (2003) Human chorionic gonadotropin in cervicovaginal secretions as a predictor of preterm delivery. Int J Gynecol Obstet (Paris) 83:151–157. doi:10.​1016/​S0020-7292(03)00273-x CrossRef
Metadata
Title
Cervicovaginal HCG and cervical length for prediction of preterm delivery in asymptomatic women at high risk for preterm delivery
Authors
Kaliprasad Adhikari
Rashmi Bagga
Vanita Suri
Sunil Arora
Shet Masih
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Archives of Gynecology and Obstetrics / Issue 4/2009
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-009-0957-8

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