Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran.
Faculty of Medicine, University of Exeter, Exeter, UK.
J Matern Fetal Neonatal Med. 2022 Feb;35(3):534-540. doi: 10.1080/14767058.2020.1728246. Epub 2020 Feb 18.
Since the capacity of tertiary centers is limited, identifying women with the risk of preterm delivery is crucial amongst women who refer to hospitals with threatened preterm labor.
The purpose of the present study was to evaluate the accuracy of the placental alpha microglobulin-1 (PAMG-1) test for identifying women who referred to hospitals with signs of spontaneous preterm labor and ultimately delivered within ≤48 h and ≤7 of testing and ≤37 weeks of gestation and its comparison with cervical length of <25 mm and number of contractions.
A prospective observational study was performed on women with the signs of spontaneous preterm labor. Placental alpha microglobulin-1 (PAMG-1) was evaluated in vaginal secretion. Cervical length (CL) and number of contractions were evaluated and recorded. The test to- spontaneous- delivery interval was documented. Sensitivity (SN), specificity (SP), accuracy rate of the PAMG-1, cervical length of <25 mm and number of contractions in prediction of spontaneous preterm delivery within ≤48 h, ≤7 days and preterm delivery (≤37 weeks of gestation) were calculated.
One hundred eighty women finished the study. 44 women had positive PAMG-1 test and 58 women had cervical length of <25 mm. Women with a positive PAMG-1 were more likely to deliver within ≤48 h ( < .0001), ≤7 days ( < .0001), and before 37 weeks ( < .0001), compared to the women who had a negative test. For delivery within ≤48 h, ≤7 days and ≤37 weeks, specificity (SP) of the PAMG-1; was statistically higher than cervical length of <25 mm and contractions of 12-17/hr but not contractions of ≥18/hr. PAMG-1 showed a higher accuracy rate than cervical length of <25 mm, contractions of 12-17/hr and contractions of ≥18/hr for deliveries within ≤48 h (78.9, 55.3, 48.9, and 69.44%, respectively) and ≤7 days (76.1, 55.32, 55, and 65.56%, respectively). For deliveries before 37 weeks; the PAMG-1 test showed higher LR + than CL of <25 mm, contractions of 12-17/hr and contractions of ≥18/hr [10.24 (2.57-40.86), 2.01 (1.24-3.23), 1.30 (1.05-1.62), and 5.12 (1.24-21.11), respectively]. PPV for deliveries within ≤48 h and ≤7 days for PAMG-1 was greater than cervical length of <25 mm and number of contractions, however, NPV did not show a significant difference.
PAMG-1 test showed a higher accuracy rate for prediction of delivery within ≤48 and ≤7 days in comparison with cervical length of <25 mm and number of contractions. Also, PAMG-1 test had a higher positive likelihood ratio for deliveries at ≤37 weeks. PPV for deliveries within ≤48 h and ≤7 days for PAMG-1 was greater than cervical length of <25 mm and number of contractions, however, NPV did not show a significant difference.
由于三级中心的容量有限，因此确定有早产风险的妇女对于那些有早产迹象并最终在 ≤48 小时内分娩的妇女至关重要。
本研究旨在评估胎盘α微球蛋白-1（PAMG-1）检测用于识别有自发性早产迹象并最终在 ≤48 小时内分娩和 ≤7 天内分娩和 ≤37 周妊娠的妇女的准确性，并与宫颈长度 <25 毫米和宫缩数进行比较。
对有自发性早产迹象的妇女进行前瞻性观察研究。评估阴道分泌物中的胎盘α微球蛋白-1（PAMG-1）。评估并记录宫颈长度（CL）和宫缩数。记录从检测到自发分娩的时间间隔。计算 PAMG-1、宫颈长度 <25 毫米和宫缩数在预测 ≤48 小时、 ≤7 天和早产（ ≤37 周妊娠）内自发性早产的敏感性（SN）、特异性（SP）、准确性。
180 名妇女完成了研究。44 名妇女的 PAMG-1 检测呈阳性，58 名妇女的宫颈长度 <25 毫米。与阴性检测的妇女相比，PAMG-1 阳性的妇女更有可能在 ≤48 小时内（ < .0001）、 ≤7 天（ < .0001）和 37 周前（ < .0001）分娩。对于 ≤48 小时、 ≤7 天和 ≤37 周的分娩，PAMG-1 的特异性（SP）；与宫颈长度 <25 毫米和 12-17 次/小时的宫缩相比，统计学上更高，但与 ≥18 次/小时的宫缩相比则不是。与宫颈长度 <25 毫米、12-17 次/小时和 ≥18 次/小时的宫缩相比，PAMG-1 对 ≤48 小时内（分别为 78.9%、55.3%、48.9%和 69.44%）和 ≤7 天内（分别为 76.1%、55.32%、55%和 65.56%）的分娩具有更高的准确性。对于 37 周前的分娩；PAMG-1 试验显示的阳性似然比高于宫颈长度 <25 毫米、宫缩 12-17 次/小时和宫缩 ≥18 次/小时[10.24（2.57-40.86）、2.01（1.24-3.23）、1.30（1.05-1.62）和 5.12（1.24-21.11）]。在 ≤48 小时和 ≤7 天内分娩时，PAMG-1 的阳性预测值大于宫颈长度 <25 毫米和宫缩数，但阴性预测值无显著差异。
与宫颈长度 <25 毫米和宫缩数相比，PAMG-1 试验对预测 ≤48 小时和 ≤7 天内分娩具有更高的准确性。此外，PAMG-1 试验对 ≤37 周分娩的阳性似然比更高。在 ≤48 小时和 ≤7 天内分娩时，PAMG-1 的阳性预测值大于宫颈长度 <25 毫米和宫缩数，但阴性预测值无显著差异。
