Risk stratification with cervical length and fetal fibronectin in women with threatened preterm labor before 34 weeks and not delivering within 7 days
Hermans, Frederik J R; Bruijn, Merel M C; Vis, Jolande Y; Wilms, Femke F; Oudijk, Martijn A; Porath, Martina M; Scheepers, Hubertina C J; Bloemenkamp, Kitty W M; Bax, Caroline J; Cornette, Jérôme M J; Nij Bijvanck, Bas W A; Franssen, Maureen T M; Vandenbussche, Frank P H A; Kok, Marjolein; Grobman, William A; Van Der Post, Joris A M; Bossuyt, Patrick M M; Opmeer, Brent C; Mol, Ben Willem J; Schuit, Ewoud; Van Baaren, Gert-Jan
(2015) Acta Obstetricia et Gynecologica Scandinavica, volume 94, issue 7, pp. 715 - 721
(Article)
Abstract
OBJECTIVE: To stratify the risk of spontaneous preterm delivery using cervical length (CL) and fetal fibronectin (fFN) in women with threatened preterm labor who remained pregnant after 7 days. DESIGN: Prospective observational study. SETTING: Nationwide cohort of women with threatened preterm labor from the Netherlands. POPULATION: Women with threatened preterm
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labor between 24 and 34 weeks with a valid CL and fFN measurement and remaining pregnant 7 days after admission. METHODS: Kaplan-Meier and Cox proportional hazards models were used to estimate cumulative percentages and hazard ratios (HR) for spontaneous delivery. MAIN OUTCOME MEASURES: Spontaneous delivery between 7 and 14 days after initial presentation and spontaneous preterm delivery before 34 weeks. RESULTS: The risk of delivery between 7 and 14 days was significantly increased for women with a CL < 15 mm or a CL ≥15 to <30 mm and a positive fFN, compared with women with a CL ≥30 mm: HR 22.3 [95% confidence interval (CI) 2.6-191] and 14 (95% CI 1.8-118), respectively. For spontaneous preterm delivery before 34 weeks the risk was increased for women with a CL < 15 mm [HR 6.3 (95% CI 2.6-15)] or with a CL ≥15 to <30 mm with either positive fFN [HR 3.6 (95% CI 1.5-8.7)] or negative fFN [HR 3.0 (95% CI 1.2-7.1)] compared with women with a CL ≥ 30 mm. CONCLUSIONS: In women remaining pregnant 7 days after threatened preterm labor, CL and fFN results can be used in risk stratification for spontaneous delivery.
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Keywords: Adult, Cervical Length Measurement, Female, Fibronectins, Humans, Netherlands, Obstetric Labor, Premature, Pregnancy, Premature Birth, Proportional Hazards Models, Prospective Studies, Risk Assessment, Term Birth, Journal Article, Multicenter Study
ISSN: 0001-6349
Publisher: Wiley-Blackwell
Note: © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.
(Peer reviewed)