Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey.
J Matern Fetal Neonatal Med. 2022 Sep;35(17):3388-3392. doi: 10.1080/14767058.2020.1818222. Epub 2020 Nov 22.
Preterm labor is the leading cause of premature mortality and morbidity. Therefore, to rule-in and rule-out preterm delivery is a very important issue in our clinical practice.
The aim of this study was to investigate the value of placental alpha microglobulin-1 (PAMG-1) molecule positivity in cervicovaginal secretions of women who have a CL <25 mm and presenting with preterm labor symptoms to predict spontaneous preterm birth within seven days.
This was a prospective cohort study conducted in Ankara University Department of Obstetrics and Gynecology between August 2017 and February 2019 on the patients who had Preterm labor symptoms, <25 mm transvaginal cervical length (CL), clinically intact membranes. The primary outcome of the study was the power of CL and PAMG-1 positivity on the prediction of preterm birth in seven days.
Sensitivity and specificity values of PAMG-1 in our study population to predict spontaneous preterm birth in seven days were calculated 52.94% and 98.84%, respectively, negative predictive value (NPV) and positive predictive value (PPV) were calculated 91.4% and 90%, respectively. When we investigated our data according to different CL cutoffs, sensitivity and NPV for 20 mm cutoff were 88.24% and 96.3% that was better than PAMG-1, but specificity and PPV were 60.47% and 30.61%, respectively, that was more ineffective than PAMG-1. If we calculate the values according to 15 mm and 10 mm CL cutoffs sensitivity values were 58.8% and 23.53%, specificity values were 81.4% and 91.86%, NPV were 90.9% and 85.87%, PPV were 38.46% and 36.36%, respectively. Finally, accuracy value of PAMG-1 to predict spontaneous preterm birth in seven days was 91.26% that was better than other CL cutoffs (20 mm, 15 mm, and 10 mm).
PAMG-1 molecule with high NPV and PPV (91.4% and 90%) combination will contribute our clinical decision on the population who had preterm labor symptoms and a CL shorter than 25 mm.
早产是导致早产儿死亡和发病的主要原因。因此，准确地预测早产的发生对于我们的临床实践非常重要。
本研究旨在探讨胎盘α微球蛋白-1（PAMG-1）分子在宫颈长度（CL）<25mm 且有早产症状的女性阴道分泌物中的阳性表达，以预测 7 天内自发性早产的发生。
本研究为前瞻性队列研究，于 2017 年 8 月至 2019 年 2 月在安卡拉大学妇产科进行，纳入有早产症状、CL<25mm、临床胎膜完整的患者。研究的主要结局是 CL 和 PAMG-1 阳性对 7 天内早产的预测能力。
在本研究人群中，PAMG-1 预测 7 天内自发性早产的敏感性和特异性值分别为 52.94%和 98.84%，阴性预测值（NPV）和阳性预测值（PPV）分别为 91.4%和 90%。当我们根据不同的 CL 截断值来研究数据时，20mm 截断值的敏感性和 NPV 分别为 88.24%和 96.3%，优于 PAMG-1，但特异性和 PPV 分别为 60.47%和 30.61%，不如 PAMG-1有效。如果我们根据 15mm 和 10mm CL 截断值计算值，敏感性值分别为 58.8%和 23.53%，特异性值分别为 81.4%和 91.86%，NPV 分别为 90.9%和 85.87%，PPV 分别为 38.46%和 36.36%。最后，PAMG-1 预测 7 天内自发性早产的准确率为 91.26%，优于其他 CL 截断值（20mm、15mm 和 10mm）。
PAMG-1 分子具有较高的 NPV 和 PPV（91.4%和 90%），结合起来将有助于我们对有早产症状且 CL<25mm 的人群做出临床决策。
