Fichera Anna, Prefumo Federico, Zanardini Cristina, Stagnati Valentina, Frusca Tiziana
Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Brescia, Italy.
Prenat Diagn. 2014 May;34(5):450-9. doi: 10.1002/pd.4328. Epub 2014 Feb 20.
Objective This study aimed to assess the accuracy of a second-trimester rapid cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) test to predict spontaneous preterm delivery in asymptomatic twin pregnancies. Method During the second trimester, a rapid test to detect phIGFBP-1 in cervical secretions was performed on consecutive twin pregnancies between 2009 and 2011, to evaluate its predictive value for spontaneous preterm delivery at <28, <30, <32 and <34 weeks' gestation. Excluded were patients with cerclage, pessary or undergoing indicated preterm delivery. Results A total of 197 pregnancies fulfilled the study criteria and were tested at a median gestational age of 20.3 weeks (interquartile range: 20-20.6). Median gestational age at delivery was 36.4 weeks. Spontaneous preterm delivery at <34 weeks occurred in 21 (10.7%) cases, at <32 weeks in 9 (4.5%), at <30 weeks in 6 (3%) and at <28 weeks in 4 (2%). Seventeen patients (8.7%) were test positive: In this group, three patients delivered before 34 weeks' gestation, whereas none delivered at <32 weeks. The sensitivity, specificity, positive and negative predictive value of the test for spontaneous preterm delivery <34 weeks were 14% (95% confidence interval, 3-37%), 92% (86-95%), 17% (4-44%) and 90% (84-93%), respectively, with a positive and negative likelihood ratio of 1.79 (0.56-5.74) and 0.93 (0.78-1.10). Conclusions In the second trimester, rapid cervical phIGFBP-1 testing in asymptomatic twin pregnancies has a poor performance in predicting spontaneous preterm delivery.
目的 本研究旨在评估孕中期快速宫颈磷酸化胰岛素样生长因子结合蛋白-1（phIGFBP-1）检测对无症状双胎妊娠自发性早产的预测准确性。方法 在孕中期，对2009年至2011年间连续的双胎妊娠进行快速检测，以检测宫颈分泌物中的phIGFBP-1，评估其对妊娠<28周、<30周、<32周和<34周时自发性早产的预测价值。排除接受宫颈环扎术、放置子宫托或接受引产的患者。结果 共有197例妊娠符合研究标准，中位孕周为20.3周（四分位间距：20 - 20.6）。分娩时的中位孕周为36.4周。21例（10.7%）发生<34周的自发性早产，9例（4.5%）发生<32周的自发性早产，6例（3%）发生<30周的自发性早产，4例（2%）发生<28周的自发性早产。17例患者（8.7%）检测呈阳性：在该组中，3例患者在妊娠34周前分娩，而在<32周时无患者分娩。该检测对<34周自发性早产的敏感性、特异性、阳性预测值和阴性预测值分别为14%（95%置信区间，3 - 37%）、92%（86 - 95%）、17%（4 - 44%）和90%（84 - 93%），阳性似然比和阴性似然比分别为1.79（0.56 - 5.74）和0.93（0.78 - 1.10）。结论 在孕中期，无症状双胎妊娠的快速宫颈phIGFBP-1检测在预测自发性早产方面表现不佳。
