Chawanpaiboon Saifon, Titapant Vitaya, Pooliam Julaporn
Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Asian Biomed (Res Rev News). 2021 Jun 30;15(3):119-127. doi: 10.2478/abm-2021-0015. eCollection 2021 Jun.
Presence of placental α microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery.
To determine whether the accuracy of a positive PAMG-1 test result to predict preterm birth within 7 days and 14 days in our hospital setting can be improved by adding cervical length.
We recruited 180 pregnant women who attended the labor ward of Siriraj Hospital, Thailand, from 2016 to 2018 for this prospective observational study of diagnostic accuracy. We used data from 161 women who met inclusion criteria including symptoms of preterm labor between 20 and 36 weeks' gestation without ruptured membranes and with cervical dilatation <3 cm and effacement <80%. Presence of PAMG-1 in cervicovaginal fluid was tested using a PartoSure kit, cervical length was measured by transvaginal ultrasound, and the time to spontaneous delivery was calculated.
Pregnant women with labor pain who had cervical length <30 mm (45/161; 28%) went into delivery within 7 days, and women with a cervical length <15 mm (11/14; 79%) went into delivery within 7 days. When the PAMG-1 test result was positive and cervical length was ≤15 mm, the positive predictive value (PPV) was 83%; and when cervical length was ≤30 mm the PPV was 69%. The optimal cut off from receiver operating characteristic curve analysis showed that a cervical length <25 mm and PAMG-1 positive result has a PPV of 80% to predict preterm birth within 7 days and 90% within 14 days. The area under the curve (95% confidence interval) for a positive PAMG-1 result and cervical length ≤25 mm to predict preterm birth <7 days was 0.61 (0.50, 0.73) and <14 days was 0.60 (0.49, 0.70).
Cervical length ranging 15-30 mm combined with a positive PAMG-1 test result has a high accuracy to predict imminent spontaneous delivery within 7 days by women with preterm labor and cervical dilatation <3 cm in clinical practice.
宫颈阴道液中胎盘α微球蛋白-1（PAMG-1）的存在是预测早产的一种床边检测方法。
确定在我院通过增加宫颈长度是否能提高PAMG-1检测结果阳性预测7天内和14天内早产的准确性。
我们招募了180名2016年至2018年期间到泰国诗里拉吉医院产科病房就诊的孕妇，进行这项诊断准确性的前瞻性观察研究。我们使用了161名符合纳入标准的女性的数据，这些标准包括妊娠20至36周之间出现早产症状、胎膜未破、宫颈扩张<3 cm且宫颈消退<80%。使用PartoSure试剂盒检测宫颈阴道液中PAMG-1的存在，通过经阴道超声测量宫颈长度，并计算自发分娩时间。
宫颈长度<30 mm的有宫缩疼痛的孕妇（45/161；28%）在7天内分娩，宫颈长度<15 mm的孕妇（11/14；79%）在7天内分娩。当PAMG-1检测结果为阳性且宫颈长度≤15 mm时，阳性预测值（PPV）为83%；当宫颈长度≤30 mm时，PPV为69%。受试者操作特征曲线分析的最佳截断值显示，宫颈长度<25 mm且PAMG-1检测结果阳性预测7天内早产的PPV为80%，14天内为90%。PAMG-1检测结果阳性且宫颈长度≤25 mm预测早产<7天的曲线下面积（95%置信区间）为0.61（0.50，0.73），<14天的曲线下面积为0.60（0.49，0.70）。
在临床实践中，对于有早产宫缩且宫颈扩张<3 cm的女性，宫颈长度在15 - 30 mm之间并结合PAMG-1检测结果阳性对预测7天内即将发生的自发分娩具有较高的准确性。
