Abuelghar Wessam M, Ellaithy Mohamed I, Swidan Khaled H, Allam Ihab S, Haggag Heba M
a Ain Shams University Maternity Hospital , Cairo , Egypt.
b Department of Obstetrics and Gynecology , Elsalam Specialized Hospital , Elsalam City, Cairo , Egypt.
J Matern Fetal Neonatal Med. 2019 Nov;32(22):3847-3858. doi: 10.1080/14767058.2018.1482872. Epub 2018 Jun 25.
Measurement of salivary progesterone (SP4) levels and cervical length (CL) after 24 weeks to assess their potential predictive value among asymptomatic women at high risk of spontaneous preterm birth (PTB). This prospective observational (noninterventional) study consecutively recruited asymptomatic women at high risk of spontaneous PTB. SP4 and CL were measured at recruitment (24-28 weeks of gestation) then repeated after 3-4 weeks. All recruited women were followed up regularly till delivery. The primary outcome measure was the occurrence of spontaneous PTB. One hundred and thirty four women completed the study, 22 (16.4%) and 32 (23.9%) women had early (<34 weeks) and late (≥34 weeks) PTB, respectively. Initially, the mean CL was 3.2 ± 0.6 cm and the mean SP4 was 4062.8 ± 814.6 pg/ml; with follow up, the mean CL became 3.0 ± 0.6 cm and the mean SP4 became 3871.6 ± 1136.9. Women with early PTB had significantly lower initial and follow up CL and SP4 measures when compared to women with late PTB and those who had birth at term. The rate of drop in SP4 and CL measurements between the two visits was also significantly higher among women with early PTB than those with late PTB and term birth. Receiver-operating characteristic (ROC) curves showed that, CL was a good predictor but SP4 was a better predictor of PTB as the area under the curve (AUC) for CL was less than that for SP4 at both visits (i.e. 0.858 and 0.868 versus 0.986 and 0.990 at the initial and follow up visits, respectively). There was a statistically significant correlation between CL and SP4 measurements. Multivariable binary logistic regression analysis revealed that follow up SP4 measurement was the only independent predictor of spontaneous PTB, and neither BMI, maternal age, SP4 nor CL were independent predictors of early spontaneous PTB. After 24 gestational weeks, SP4 assessment is a simple and reliable promising tool to predict spontaneous PTB among asymptomatic high-risk women, with a little superior performance than CL measurement.
测量24周后唾液孕酮（SP4）水平和宫颈长度（CL），以评估其在无症状的自发性早产（PTB）高危女性中的潜在预测价值。这项前瞻性观察性（非干预性）研究连续招募了无症状的自发性PTB高危女性。在招募时（妊娠24 - 28周）测量SP4和CL，然后在3 - 4周后重复测量。所有招募的女性均定期随访直至分娩。主要结局指标是自发性PTB的发生情况。134名女性完成了研究，分别有22名（16.4%）和32名（23.9%）女性发生了早期（<34周）和晚期（≥34周）PTB。最初，平均CL为3.2±0.6cm，平均SP4为4062.8±814.6pg/ml；随访后，平均CL变为3.0±0.6cm，平均SP4变为3871.6±1136.9。与晚期PTB女性和足月分娩女性相比，早期PTB女性的初始和随访CL及SP4测量值显著更低。早期PTB女性两次测量之间SP4和CL的下降率也显著高于晚期PTB女性和足月分娩女性。受试者工作特征（ROC）曲线显示，CL是一个良好的预测指标，但SP4是更好的PTB预测指标，因为两次测量时CL的曲线下面积（AUC）均小于SP4（即初始和随访时分别为0.858和0.868，而SP4分别为0.986和0.990）。CL和SP4测量值之间存在统计学显著相关性。多变量二元逻辑回归分析显示，随访SP4测量值是自发性PTB的唯一独立预测指标，而BMI、母亲年龄、SP4和CL均不是早期自发性PTB的独立预测指标。妊娠24周后，SP4评估是预测无症状高危女性自发性PTB的一种简单、可靠且有前景的工具，其性能略优于CL测量。
