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Shen H, Zhang L, Bai H, Wu L, Du L, Xie H. Knowledge mapping for prediction of spontaneous preterm birth. Eur J Obstet Gynecol Reprod Biol 2025; 309:79-88. [PMID: 40112460 DOI: 10.1016/j.ejogrb.2025.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/18/2025] [Accepted: 03/08/2025] [Indexed: 03/22/2025]
Abstract
INTRODUCTION Preterm birth (PTB) before 37 weeks gestation, especially spontaneous premature birth (sPTB), poses significant global health challenges, with rising rates linked to advanced and multiple pregnancies. Despite efforts to understand the pathogenesis and related biomarkers of sPTB, accurate prediction is still difficult to achieve. Recent research in academic journals has focused on sPTB prediction, prompting our bibliometric analysis to understand the current situation and explore the new research direction. METHODS We used keywords in the Web of Science Core Collection (WoSCC) to search for articles related to sPTB prediction from 2004 to 2023. Subsequently, we primarily employed three distinct software tools (VOSviewer, CiteSpace, and Python) for conducting this bibliometric analysis. RESULTS Focusing on sPTB as the primary subject, a total of 647 papers have been published in 136 academic journals. There are the most publications from The United States (n = 245, 39.26 %), and the University of London contributed the most publications (n = 57, 8.81 %). The American Journal of Obstetrics and Gynecology is the most productive academic journal on sPTB prediction [n = 74, 11.44 %; impact factor (IF) = 8.7]. Through the co-occurrence and cluster analysis, we found that recent research has focused on is "pamg-1", "uterocervical angle", "twin pregnancy", "quantitative ultrasound", and "lactobacillus iners". CONCLUSION We utilized bibliometric software to perform a comprehensive analysis of the literature concerning sPTB prediction. Broadly, the primary focus of future sPTB prediction lies in the application of novel ultrasound and biological markers, as well as in predicting sPTB in twin pregnancies.
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Affiliation(s)
- Hui Shen
- Department of Ultrasonic Medicine, Fetal Medical Centre, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Lihe Zhang
- Department of Ultrasonic Medicine, Fetal Medical Centre, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Han Bai
- Department of Ultrasonic Medicine, Fetal Medical Centre, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Lihong Wu
- Department of Ultrasonic Medicine, Fetal Medical Centre, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Liu Du
- Department of Ultrasonic Medicine, Fetal Medical Centre, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Hongning Xie
- Department of Ultrasonic Medicine, Fetal Medical Centre, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Elkahlout R, Mohammed SGAA, Najjar A, Farrell T, Rifai HA, Al‐Dewik N, Qoronfleh MW. Application of Proteomics in Maternal and Neonatal Health: Advancements and Future Directions. Proteomics Clin Appl 2025; 19:e70004. [PMID: 40128623 PMCID: PMC12069003 DOI: 10.1002/prca.70004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Accepted: 02/26/2025] [Indexed: 03/26/2025]
Abstract
Maternal and neonatal health (women during pregnancy, childbirth, and the postnatal period) presents a spectrum of healthcare challenges, including preterm birth, preeclampsia, intrauterine growth restriction, polycystic ovarian syndrome, and gestational diabetes mellitus. While genomic investigations have shed light on many of these topics, protein biomarker discovery, a pivotal aspect of such research, holds promise in offering insights into disease diagnosis, progression, and prognosis. This review paper aims to explore the landscape of proteomics research pertaining to the aforementioned disorders. In the search for viable biomarkers, existing ones are either outdated or lack specificity and new ones being investigated do not commonly make it to the validation stage. In this review, the reasons for the gap between the biomarker discovery stage and the clinical validation stage are evaluated, in addition to what steps are being taken to mitigate the unexpectedly slow scientific and clinical progress. Notably, this paper also delves into the ethnic disparities found in maternal and neonatal health research, as well as how AI is currently being used to alleviate socioeconomic and ethnic disparities, as well as its advantages for the analysis of large "omics" datasets. We anticipate this investigation will provide critical, invaluable information for researchers, medical professionals, and policy decision-makers in this field to improve overall maternal and neonatal health outcomes.
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Affiliation(s)
- Razan Elkahlout
- Department of Research, Women's Wellness and Research CenterHamad Medical Corporation (HMC)DohaQatar
- Translational and Precision Medicine Research, Women's Wellness and Research Center (WWRC)Hamad Medical Corporation (HMC)DohaQatar
| | | | - Ahmed Najjar
- AtomGenİstanbulTürkiye
- Healix Lab, Al Khuwair SouthMuscatOman
| | - Thomas Farrell
- Department of Research, Women's Wellness and Research CenterHamad Medical Corporation (HMC)DohaQatar
| | - Hilal Al Rifai
- Neonatal Intensive Care Unit (NICU), Newborn Screening Unit, Department of Pediatrics and Neonatology, Women's Wellness and Research Center (WWRC)Hamad Medical Corporation (HMC)DohaQatar
| | - Nader Al‐Dewik
- Department of Research, Women's Wellness and Research CenterHamad Medical Corporation (HMC)DohaQatar
- Translational and Precision Medicine Research, Women's Wellness and Research Center (WWRC)Hamad Medical Corporation (HMC)DohaQatar
- Neonatal Intensive Care Unit (NICU), Newborn Screening Unit, Department of Pediatrics and Neonatology, Women's Wellness and Research Center (WWRC)Hamad Medical Corporation (HMC)DohaQatar
- Genomics and Precision Medicine (GPM), College of Health & Life Science (CHLS)Hamad Bin Khalifa University (HBKU)DohaQatar
- Faculty of Health and Social Care SciencesKingston University, St. George's University of LondonLondonUK
| | - M. Walid Qoronfleh
- AtomGenİstanbulTürkiye
- Healix Lab, Al Khuwair SouthMuscatOman
- Healthcare Research & Policy DivisionQ3 Research Institute (QRI)Ann ArborMichiganUSA
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Belaghi RA. Prediction of preterm birth in multiparous women using logistic regression and machine learning approaches. Sci Rep 2024; 14:21967. [PMID: 39304672 DOI: 10.1038/s41598-024-60097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/18/2024] [Indexed: 09/22/2024] Open
Abstract
To predict preterm birth (PTB) in multiparous women, comparing machine learning approaches with traditional logistic regression. A population-based cohort study was conducted using data from the Ontario Better Outcomes Registry and Network (BORN). The cohort included all multiparous women who delivered a singleton birth at 20-42 weeks' gestation in an Ontario hospital between April 1, 2012 and March 31, 2014. The primary outcome was PTB < 37 weeks, with spontaneous PTB analyzed as a secondary outcome. Stepwise logistic regression and the Boruta machine learning were used to select the important variables during the first and second trimester. For building prediction models, the whole data set were divided for the two independent parts: two-third for training the classifiers (Logistic regression, random forests, decision trees, and artificial neural networks) and one-third for model validation. Then, the training data set were balanced by random over sampling technique. The best hyper parameters were obtained by the tenfold cross validation. The performance of all models was evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristics (AUC). The cohort included 145,846 births, of which 8125 (5.57%) were preterm. In first-trimester models, the strongest predictors of PTB were previous PTB, preexisting diabetes, and abnormal pregnancy-associated plasma protein-A. In the testing data set, the highest predictive ability was seen for artificial neural networks, with an area under the receiver operating characteristic curve (AUC) of 68.8% (95% CI 67.6-70.1%). In second-trimester models, addition of infant sex, attendance at first-trimester appointment, medication exposure, and abnormal alpha-fetoprotein concentrations increased the AUC to 72.1% (95% CI 71.1-73.1%) with logistic regression. With the inclusion of the variable complications during pregnancy, the AUC increased to 80.5% (95% CI 79.6-81.5%) using logistic regression. For both overall and spontaneous PTB, during both the first and second trimesters, models yielded negative predictive values of 97%. Overall, machine learning and logistic regression produced similar performance for prediction of PTB. For overall and spontaneous PTB, both first- and second-trimester models provided negative predictive values of ~ 97%, higher than that of fetal fibronectin.
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Affiliation(s)
- Reza Arabi Belaghi
- Clinical Research Unit (CRU), CHEO Research Institute, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada.
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Wahid HH, Anahar FN, Isahak NH, Mohd Zoharodzi J, Mohammad Khoiri SNL, Mohamad Zainal NH, Kamarudin N, Ismail H, Mustafa Mahmud MIA. Role of Platelet Activating Factor as a Mediator of Inflammatory Diseases and Preterm Delivery. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:862-878. [PMID: 38403163 DOI: 10.1016/j.ajpath.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
Nearly 70% of preterm deliveries occur spontaneously, and the clinical pathways involved include preterm labor and preterm premature rupture of membranes. Prediction of preterm delivery is considered crucial due to the significant effects of preterm birth on health and the economy at both the personal and community levels. Although similar inflammatory processes occur in both term and preterm delivery, the premature activation of these processes or exaggerated inflammatory response triggered by infection or sterile factors leads to preterm delivery. Platelet activating factor (PAF) is a phosphoglycerylether lipid mediator of inflammation that is implicated in infections, cancers, and various chronic diseases and disorders including cardiovascular, renal, cerebrovascular, and central nervous system diseases. In gestational tissues, PAF mediates the inflammatory pathways that stimulate the effector mechanisms of labor, including myometrial contraction, cervical dilation, and fetal membrane rupture. Women with preterm labor and preterm premature rupture of membranes have increased levels of PAF in their amniotic fluid. In mice, the intrauterine or intraperitoneal administration of carbamyl PAF activates inflammation in gestational tissues, thereby eliciting preterm delivery. This review summarizes recent research on PAF as an important inflammatory mediator in preterm delivery and in other inflammatory disorders, highlighting its potential value for prediction, intervention, and prevention of these diseases.
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Affiliation(s)
- Hanan H Wahid
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University, Pahang, Malaysia.
| | - Fatin N Anahar
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University, Pahang, Malaysia
| | - Nurul H Isahak
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University, Pahang, Malaysia
| | - Juwairiyah Mohd Zoharodzi
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University, Pahang, Malaysia
| | - Siti N L Mohammad Khoiri
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University, Pahang, Malaysia
| | - Nurul H Mohamad Zainal
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, University of Putra Malaysia, Selangor, Malaysia
| | - Norhidayah Kamarudin
- Department of Pathology, Kulliyyah of Medicine, International Islamic University, Pahang, Malaysia
| | - Hamizah Ismail
- Department of Obstetrics & Gynaecology, Kulliyyah of Medicine, International Islamic University, Pahang, Malaysia
| | - Mohammed I A Mustafa Mahmud
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University, Pahang, Malaysia
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Roca-Prats A, Diaz-Martinez A, Albaladejo-Belmonte M, Alberola-Rubio J, Monfort-Ortiz R, Martínez-Triguero ML, Marcos-Puig B, Perales-Marín A. Outperformance of interleukin-6 over placental alpha microglobulin-1 in predicting preterm delivery in symptomatic women. Am J Obstet Gynecol MFM 2023; 5:101125. [PMID: 37549734 DOI: 10.1016/j.ajogmf.2023.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Threatened preterm labor is the major cause of hospital admission during the second half of pregnancy. An early diagnosis is crucial for adopting pharmacologic measures to reduce perinatal mortality and morbidity. Current diagnostic criteria are based on symptoms and short cervical length. However, there is a high false-positive rate when using these criteria, which implies overtreatment, causing unnecessary side effects and an avoidable economic burden. OBJECTIVE This study aimed to compare the use of placental alpha microglobulin-1 and interleukin-6 as vaginal biomarkers combined with cervical length and other maternal characteristics to improve the prediction of preterm delivery in symptomatic women. STUDY DESIGN A prospective observational study was conducted in women with singleton pregnancies complicated by threatened preterm labor with intact membranes at 24+0 to 34+6 weeks of gestation. A total of 136 women were included in this study. Vaginal fluid was collected with a swab for placental alpha microglobulin-1 determination using the PartoSure test, interleukin-6 was assessed by electrochemiluminescence immunoassay, cervical length was measured by transvaginal ultrasound, and obstetrical variables and newborn details were retrieved from clinical records. These characteristics were used to fit univariate binary logistic regression models to predict time to delivery <7 days, time to delivery <14 days, gestational age at delivery ≤34 weeks, and gestational age at delivery ≤37 weeks, and multivariate binary logistic regression models were fitted with imbalanced and balanced data. Performance of models was assessed by their F2-scores and other metrics, and the association of their variables with a risk or a protective factor was studied. RESULTS A total of 136 women were recruited, of whom 8 were lost to follow-up and 7 were excluded. Of the remaining 121 patients, 22 had a time to delivery <7 days and 31 had a time to delivery <14 days, and 30 deliveries occurred with a gestational age at delivery ≤34 weeks and 55 with a gestational age at delivery ≤37 weeks. Univariate binary logistic regression models fitted with the log transformation of interleukin-6 showed the greatest F2-scores in most studies, which outperformed those of models fitted with placental alpha microglobulin-1 (log[interleukin-6] vs placental alpha microglobulin-1 in time to delivery <7 days: 0.38 vs 0.30; time to delivery <14 days: 0.58 vs 0.29; gestational age at delivery ≤34 weeks: 0.56 vs 0.29; gestational age at delivery ≤37 weeks: 0.61 vs 0.16). Multivariate logistic regression models fitted with imbalanced data sets outperformed most univariate models (F2-score in time to delivery <7 days: 0.63; time to delivery <14 days: 0.54; gestational age at delivery ≤34 weeks: 0.62; gestational age at delivery ≤37 weeks: 0.73). The performance of prediction of multivariate models was drastically improved when data sets were balanced, and was maximum for time to delivery <7 days (F2-score: 0.88±0.2; positive predictive value: 0.86±0.02; negative predictive value: 0.89±0.03). CONCLUSION A multivariate assessment including interleukin-6 may lead to more targeted treatment, thus reducing unnecessary hospitalization and avoiding unnecessary maternal-fetal treatment.
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Affiliation(s)
- Alba Roca-Prats
- Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain (Drs Roca-Prats, Monfort-Ortiz, and Marcos-Puig).
| | - Alba Diaz-Martinez
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain (Mses Diaz-Martinez and Albaladejo-Belmonte)
| | - Monica Albaladejo-Belmonte
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain (Mses Diaz-Martinez and Albaladejo-Belmonte)
| | - Jose Alberola-Rubio
- Unidad de Bioelectrónica, Signal Processing y Algoritmia, Instituto de Investigación Sanitaria La Fe, Valencia, Spain (Dr Alberola-Rubio)
| | - Rogelio Monfort-Ortiz
- Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain (Drs Roca-Prats, Monfort-Ortiz, and Marcos-Puig)
| | - María L Martínez-Triguero
- Laboratory Department, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Martínez-Triguero)
| | - Beatriz Marcos-Puig
- Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain (Drs Roca-Prats, Monfort-Ortiz, and Marcos-Puig)
| | - Alfredo Perales-Marín
- Faculty of Medicine and Odontology, Department of Pediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain (Dr Perales-Marín)
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Hoffmann JA, Gründler K, Richter DU, Stubert J. Prediction of spontaneous preterm birth using CCL2 and CXCL10 in maternal serum of symptomatic high-risk pregnant women: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:697. [PMID: 37770883 PMCID: PMC10537471 DOI: 10.1186/s12884-023-06016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/21/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION CCL2 and CXCL10 are putative biomarkers for the prediction of spontaneous preterm birth. This study evaluates these markers in a cohort of pregnant high-risk women. MATERIAL AND METHODS In our prospective study, we included 109 women with signs of preterm labor between 20 + 0 and 31 + 6 weeks of gestation. Inclusion criteria were regular (< 3/30 min) or painful contractions, cervical length < 25 mm or a history of previous preterm birth (PTB). Blood samples were obtained upon first admission to our clinic. Biomarker concentrations were measured using pre-coated sandwich immunoassays (ELISA). Primary study outcome was spontaneous preterm birth < 34 weeks, secondary outcome was delivery < 37 weeks or within seven days after study inclusion. RESULTS Sixteen women (14.7%) delivered < 34 weeks and twenty women between 34 + 0 and 36 + 6 weeks (18.4%). Six patients (5.5%) gave birth within seven days after study admission. CXCL10 showed higher medium serum levels in women with PTB < 34 weeks (115 pg/ml compared to 61 pg/ml ≥ 34 weeks; p < 0.001) and < 37 weeks (103 pg/ml vs. 53 pg/ml; p < 0.001). In contrary, lower CCL2 serum levels were associated with PTB < 34 weeks (46 pg/ml vs. 73 pg/ml; p = 0.032) and birth within 7 days (25 pg/ml vs. 73 pg/ml; p = 0.008). The CXCL10/CCL2-ratio further improved the predictive model with a ROC-AUC of 0.83 (95% CI 0.73-0.93, p < 0.001) for delivery < 34 weeks. These corresponds to a sensitivity, specificity and positive predictive value of 0.67, 0.86 and 0.43 at a cut-off of 2.2. CONCLUSION Low maternal serum CCL2 levels are associated with a higher risk of preterm delivery within seven days. High CXCL10 serum levels are more associated with a high risk for preterm birth < 34 weeks. Elevated CXCL10/CCL2-ratio is showing the best predictive performance. TRIAL REGISTRATION NUMBER (DRKS-ID) DRKS00010763, Registration date: September 02, 2016.
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Affiliation(s)
- Jessica Alana Hoffmann
- Department of Obstetrics and Gynecology, Rostock University Medical Centre, Rostock, Germany
| | - Kathleen Gründler
- Department of Obstetrics and Gynecology, HELIOS Hospital Schwerin, Schwerin, Germany
| | - Dagmar- Ulrike Richter
- Department of Obstetrics and Gynecology, Rostock University Medical Centre, Rostock, Germany
| | - Johannes Stubert
- Department of Obstetrics and Gynecology, Rostock University Medical Centre, Rostock, Germany.
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Molina FS, Pardo L, Muñoz MD, Aiartzaguena A, Valladolid A, Blanco JE, Burgos J, Gil MM. Reproducibility and usability assessment of the novel Fine Birth device for threatened preterm labor diagnosis. Am J Obstet Gynecol MFM 2023; 5:100982. [PMID: 37094638 DOI: 10.1016/j.ajogmf.2023.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/24/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Preterm delivery is considered the leading cause of mortality worldwide in children under 5 years old. Approximately 45 million pregnant women are hospitalized yearly for threatened preterm labor. However, only 50% of pregnancies complicated by threatened preterm labor end in delivery before the estimated date, classifying the rest as false threatened preterm labor. The ability of current diagnostic methods to predict threatened preterm labor is low (low positive predictive value), ranging between 8% and 30%. This highlights the need for a solution that accurately detects and differentiates between false and real threatened preterm labors in women who attend obstetrical clinics and hospital emergency departments with delivery symptoms. OBJECTIVE Primarily, this aimed to assess the reproducibility and usability of a novel medical device, the Fine Birth, aimed at accurately diagnosing threatened preterm labor through the objective quantification of pregnant women's cervical consistency. Secondarily, this study aimed to evaluate the effect of training and the incorporation of a lateral microcamera on the device's reliability and usability outcomes. STUDY DESIGN A total of 77 singleton pregnant women were recruited during their follow-up visits to the obstetrical and gynecologic departments at 5 Spanish hospitals. The eligibility criteria included pregnant women aged ≥18 years; women with a normal fetus and uncomplicated pregnancy; women without prolapse of membranes, uterine anomalies, previous cervical surgery, or latex allergy; and women signing the informed written consent. Cervical tissue stiffness was assessed using the Fine Birth device, whose technology is based on the propagation of torsional waves through the studied tissue. Cervical consistency measurements were taken for each woman until obtaining 2 valid measurements by 2 different operators. The intraobserver and interobserver reproducibilities of the Fine Birth measurements were assessed using the intraclass correlation coefficients with a 95% confidence interval and the Fisher test P value. The usability was evaluated on the basis of the clinicians' and participants' feedback. RESULTS There was good intraobserver reproducibility (intraclass correlation coefficient, 0.88; 95% confidence interval, 0.84-0.95; Fisher test P value<.05). As the results obtained for the interobserver reproducibility did not reach the desired acceptable values (intraclass correlation coefficient of <0.75), a lateral microcamera was added to the Fine Birth intravaginal probe, and the operators involved in the clinical investigation received the corresponding training with the modified device. The analysis of 16 additional subjects demonstrated excellent interobserver reproducibility (intraclass correlation coefficient, 0.93; 95% confidence interval, 0.78-0.97) and an improvement after the intervention (P<.0001). CONCLUSION The robust reproducibility and usability results obtained after the insertion of a lateral microcamera and the corresponding training make the Fine Birth a promising novel device to objectively quantify the patient's cervical consistency, diagnose threatened preterm labor, and, thus, predict the risk of spontaneous preterm birth. Further research is needed to demonstrate the clinical utility of the device.
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Affiliation(s)
- Francisca Sonia Molina
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria, Granada, Spain (Drs Molina and Pardo).
| | - Laura Pardo
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria, Granada, Spain (Drs Molina and Pardo)
| | - Maria D Muñoz
- Hospital Universitario de Torrejón, Madrid, Spain (Drs Muñoz and Gil)
| | - Amaia Aiartzaguena
- Hospital Universitario de Cruces, Barakaldo, Spain (Drs Aiartzaguena and Burgos)
| | | | - José E Blanco
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain (Dr Blanco)
| | - Jorge Burgos
- Hospital Universitario de Cruces, Barakaldo, Spain (Drs Aiartzaguena and Burgos)
| | - María Mar Gil
- Hospital Universitario de Torrejón, Madrid, Spain (Drs Muñoz and Gil); School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain (Dr Gil).
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Melchor Corcóstegui I, Unibaso Rodríguez E, Ruiz Blanco N, Nikolova T, Nikolova N, Burgos San Cristóbal J, Melchor Marcos JC. Is mid-trimester cervical length screening effective for reduction of threatened preterm labor? Taiwan J Obstet Gynecol 2023; 62:412-416. [PMID: 37188445 DOI: 10.1016/j.tjog.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To assess the incidence of threatened preterm labor and preterm labor admissions and treatment of women with singleton gestations and no prior preterm birth before and after implementation of the universal mid-trimester transvaginal ultrasound cervical length screening. MATERIALS AND METHODS A retrospective cohort study included of singleton gestations without a history of preterm birth presenting with threatened preterm labor between 24 0/7 and 36 6/7 gestational week in two study periods: before and after the implementation of the universal cervical length screening. Women with cervical length <25 mm were considered being at high risk for preterm birth and were prescribed a treatment with vaginal progesterone daily. The primary outcome was the incidence of threatened preterm labor. Secondary outcomes were the incidence of preterm labor. RESULTS We have found a significant increase in the incidence of threatened preterm labor from 6.42% (410/6378) in 2011 to 11.61% (483/4158) in 2018 (p < 0.0001). Gestational age at triage consult was lower in than in 2011, although the rate of admission for threatened preterm labor was similar in both periods. There was a significant decrease in the incidence of preterm delivery <37 weeks from 25.60% in 2011 to 15.94% in 2018 (p < 0.0004). Although there was a reduction in preterm delivery ≤34 weeks, this reduction was not significant. CONCLUSION The universal mid-trimester cervical length screening in asymptomatic women is not associated with a reduction in the frequency of threatened preterm labor or the admission rate for preterm labor, but reduces the rate of preterm births.
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Affiliation(s)
- Iñigo Melchor Corcóstegui
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain
| | - Estíbaliz Unibaso Rodríguez
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain
| | - Nagore Ruiz Blanco
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain
| | - Tanja Nikolova
- Department of Obstetrics and Gynecology, Klinikum Mittelbaden Baden-Baden, Academic Teaching Hospital of Heidelberg University, Germany
| | - Natasha Nikolova
- Center of Perinatal and Reproductive Medicine, Medical School, University of Perugia, Italy
| | - Jorge Burgos San Cristóbal
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain
| | - Juan Carlos Melchor Marcos
- Department of Obstetrics and Gynecology, BioCruces Health Research Institute, Cruces University Hospital (UPV/EHU), Vizcaya, Spain.
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Huang W, Ural S, Zhu Y. Preterm labor tests: current status and future directions. Crit Rev Clin Lab Sci 2022; 59:278-296. [DOI: 10.1080/10408363.2022.2027864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Wei Huang
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Serdar Ural
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Yusheng Zhu
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Ran Y, He J, Peng W, Liu Z, Mei Y, Zhou Y, Yin N, Qi H. Development and validation of a transcriptomic signature-based model as the predictive, preventive, and personalized medical strategy for preterm birth within 7 days in threatened preterm labor women. EPMA J 2022; 13:87-106. [PMID: 35273661 PMCID: PMC8897543 DOI: 10.1007/s13167-021-00268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/24/2021] [Indexed: 12/08/2022]
Abstract
Preterm birth (PTB) is the leading cause of neonatal death. The essential strategy to prevent PTB is the accurate identification of threatened preterm labor (TPTL) women who will have PTB in a short time (< 7 days). Here, we aim to propose a clinical model to contribute to the effective prediction, precise prevention, and personalized medical treatment for PTB < 7 days in TPTL women through bioinformatics analysis and prospective cohort studies. In this study, the 1090 key genes involved in PTB < 7 days in the peripheral blood of TPTL women were ascertained using WGCNA. Based on this, the biological basis of immune-inflammatory activation (e.g., IFNγ and TNFα signaling) as well as immune cell disorders (e.g., monocytes and Th17 cells) in PTB < 7 days were revealed. Then, four core genes (JOSD1, IDNK, ZMYM3, and IL1B) that best represent their transcriptomic characteristics were screened by SVM and LASSO algorithm. Therefore, a prediction model with an AUC of 0.907 was constructed, which was validated in a larger population (AUC = 0.783). Moreover, the predictive value (AUC = 0.957) and clinical feasibility of this model were verified through the clinical prospective cohort we established. In conclusion, in the context of Predictive, Preventive, and Personalized Medicine (3PM), we have developed and validated a model to predict PTB < 7 days in TPTL women. This is promising to greatly improve the accuracy of clinical prediction, which would facilitate the personalized management of TPTL women to precisely prevent PTB < 7 days and improve maternal-fetal outcomes.
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Affiliation(s)
- Yuxin Ran
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Rd, Yuzhong District, Chongqing, 400016 China
- Chongqing Health Center for Women and Children, No. 120 Longshan Road, Yubei District, Chongqing, 401120 China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
| | - Jie He
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Rd, Yuzhong District, Chongqing, 400016 China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
| | - Wei Peng
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Rd, Yuzhong District, Chongqing, 400016 China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
| | - Zheng Liu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Rd, Yuzhong District, Chongqing, 400016 China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
| | - Youwen Mei
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Rd, Yuzhong District, Chongqing, 400016 China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
| | - Yunqian Zhou
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Rd, Yuzhong District, Chongqing, 400016 China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
| | - Nanlin Yin
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Rd, Yuzhong District, Chongqing, 400016 China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Center for Reproductive Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Rd, Yuzhong District, Chongqing, 400016 China
| | - Hongbo Qi
- Chongqing Health Center for Women and Children, No. 120 Longshan Road, Yubei District, Chongqing, 401120 China
- Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
- Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, No. 1 Yixueyuan Rd, Yuzhong District, Chongqing, 400016 China
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11
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Kehl S, Weiss C, Pretscher J, Baier F, Faschingbauer F, Beckmann MW, Stumpfe FM. The use of PAMG-1 testing in patients with preterm labor, intact membranes and a short sonographic cervix reduces the rate of unnecessary antenatal glucocorticoid administration. J Perinat Med 2021; 49:1135-1140. [PMID: 34271603 DOI: 10.1515/jpm-2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the frequency of antenatal corticosteroid (ACS) administration in cases with shortened cervical length by addition of placental alpha-microglobulin-1 (PAMG-1) testing to sonographic examination. METHODS Single centre retrospective cohort study. Rate of ACS administration was compared between cases with cervical length between 15 and 25 mm and cases with positive PAMG-1 testing and cervical length between 15 and 25 mm. We evaluated the following outcome parameters: Rate of ACS administration, gestational age at delivery, time to delivery, delivery within seven days, delivery <34 and <37 weeks' gestation, rate of admission to neonatal intensive care unit (NICU). RESULTS In total, 130 cases were included. "PAMG-1 group" consisted of 68 women, 62 cases built the "historical control group". ACS administration was performed less frequently in the "PAMG-1 cohort" (18 (26%) vs. 46 (74%); p<0.001). The rate of delivery within seven days did not differ (2 (3%) vs. 4 (6.5%); p=0.4239). The rates of delivery <34 weeks' gestation (7 (10%) vs. 9 (15%); p=0.4643) and <37 weeks' gestation (19 (28%) vs. 26 (42%); p=0.0939) did not differ. Time to delivery interval was longer in the PAMG-1 group (61.5 vs. 43 days, p=0.0117). NICU admission occurred more often in the "historical control group" (22 (38%) vs. 28 (60%); p=0.0272). CONCLUSIONS Addition of biomarker testing can help to avoid unnecessary ACS administrations in women with shortened cervical length.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Jutta Pretscher
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Friederike Baier
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian M Stumpfe
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
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12
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Stubert J, Gründler K, Gerber B, Richter DU, Dieterich M. Prediction of Spontaneous Preterm Birth in At-risk Women Using Thrombospondin 1 from Cervicovaginal Fluid: A Prospective Observational Study. Geburtshilfe Frauenheilkd 2021; 81:1055-1064. [PMID: 34531612 PMCID: PMC8437583 DOI: 10.1055/a-1486-7148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction
Thrombospondin 1, desmoplakin and stratifin are putative biomarkers for the prediction of preterm birth. This study aimed to validate the predictive capability of these biomarkers in patients at risk of preterm birth.
Materials and Methods
We included 109 women with symptoms of threatened spontaneous preterm birth between weeks 20 0/7 and 31 6/7 of gestation. Inclusion criteria were uterine contractions, cervical length of less than 25 mm, or a personal history of spontaneous preterm birth. Multiple gestations were also included. Samples of cervicovaginal fluid were taken before performing a digital examination and transvaginal ultrasound. Levels of cervicovaginal thrombospondin 1, desmoplakin and stratifin were quantified by enzyme-linked immunosorbent assays. The primary endpoint was spontaneous preterm birth before 34 + 0 weeks of gestation.
Results
Sixteen women (14.7%) delivered before 34 + 0 weeks. Median levels of thrombospondin 1 were higher in samples where birth occurred before 34 weeks vs. ≥ 34 weeks of gestation (4904 vs. 469 pg/mL, p < 0.001). Receiver operator characteristics analysis resulted in an area under the curve of 0.86 (p < 0.0001). At an optimal cut-off value of 2163 pg/mL, sensitivity, specificity, positive predictive value and negative predictive value were 0.94, 0.77, 0.42 and 0.99, respectively, with an adjusted odds ratio of 32.9 (95% CI: 3.1 – 345, p = 0.004). Multiple gestation, cervical length, and preterm labor had no impact on the results. Survival analysis revealed a predictive period of more than eight weeks. Levels of desmoplakin and stratifin did not differ between groups.
Conclusion
Thrombospondin 1 allowed long-term risk estimation of spontaneous preterm birth.
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Affiliation(s)
- Johannes Stubert
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Rostock, Germany
| | - Kathleen Gründler
- Department of Obstetrics and Gynecology, HELIOS Hospital Schwerin, Schwerin, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Rostock, Germany
| | - Dagmar-Ulrike Richter
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Rostock, Germany
| | - Max Dieterich
- Department of Obstetrics and Gynecology, Rostock University Medical Center, Rostock, Germany
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Arabi Belaghi R, Beyene J, McDonald SD. Prediction of preterm birth in nulliparous women using logistic regression and machine learning. PLoS One 2021; 16:e0252025. [PMID: 34191801 PMCID: PMC8244906 DOI: 10.1371/journal.pone.0252025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/10/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To predict preterm birth in nulliparous women using logistic regression and machine learning. DESIGN Population-based retrospective cohort. PARTICIPANTS Nulliparous women (N = 112,963) with a singleton gestation who gave birth between 20-42 weeks gestation in Ontario hospitals from April 1, 2012 to March 31, 2014. METHODS We used data during the first and second trimesters to build logistic regression and machine learning models in a "training" sample to predict overall and spontaneous preterm birth. We assessed model performance using various measures of accuracy including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) in an independent "validation" sample. RESULTS During the first trimester, logistic regression identified 13 variables associated with preterm birth, of which the strongest predictors were diabetes (Type I: adjusted odds ratio (AOR): 4.21; 95% confidence interval (CI): 3.23-5.42; Type II: AOR: 2.68; 95% CI: 2.05-3.46) and abnormal pregnancy-associated plasma protein A concentration (AOR: 2.04; 95% CI: 1.80-2.30). During the first trimester, the maximum AUC was 60% (95% CI: 58-62%) with artificial neural networks in the validation sample. During the second trimester, 17 variables were significantly associated with preterm birth, among which complications during pregnancy had the highest AOR (13.03; 95% CI: 12.21-13.90). During the second trimester, the AUC increased to 65% (95% CI: 63-66%) with artificial neural networks in the validation sample. Including complications during the pregnancy yielded an AUC of 80% (95% CI: 79-81%) with artificial neural networks. All models yielded 94-97% negative predictive values for spontaneous PTB during the first and second trimesters. CONCLUSION Although artificial neural networks provided slightly higher AUC than logistic regression, prediction of preterm birth in the first trimester remained elusive. However, including data from the second trimester improved prediction to a moderate level by both logistic regression and machine learning approaches.
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Affiliation(s)
- Reza Arabi Belaghi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
- Department of Statistics, University of Tabriz, Tabriz, Iran
| | - Joseph Beyene
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Sarah D. McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology (Division of Maternal-Fetal Medicine), McMaster University, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
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14
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The amniotic fluid cell-free transcriptome in spontaneous preterm labor. Sci Rep 2021; 11:13481. [PMID: 34188072 PMCID: PMC8242007 DOI: 10.1038/s41598-021-92439-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/03/2021] [Indexed: 02/03/2023] Open
Abstract
The amniotic fluid (AF) cell-free RNA was shown to reflect physiological and pathological processes in pregnancy, but its value in the prediction of spontaneous preterm delivery is unknown. Herein we profiled cell-free RNA in AF samples collected from women who underwent transabdominal amniocentesis after an episode of spontaneous preterm labor and subsequently delivered within 24 h (n = 10) or later (n = 28) in gestation. Expression of known placental single-cell RNA-Seq signatures was quantified in AF cell-free RNA and compared between the groups. Random forest models were applied to predict time-to-delivery after amniocentesis. There were 2385 genes differentially expressed in AF samples of women who delivered within 24 h of amniocentesis compared to gestational age-matched samples from women who delivered after 24 h of amniocentesis. Genes with cell-free RNA changes were associated with immune and inflammatory processes related to the onset of labor, and the expression of placental single-cell RNA-Seq signatures of immune cells was increased with imminent delivery. AF transcriptomic prediction models captured these effects and predicted delivery within 24 h of amniocentesis (AUROC = 0.81). These results may inform the development of biomarkers for spontaneous preterm birth.
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Farnsworth C, Schuler EE, Woodworth A, Straseski J, Pschirrer ER, Nerenz RD. AACC Guidance Document on Laboratory Testing for the Assessment of Preterm Delivery. J Appl Lab Med 2021; 6:1032-1044. [PMID: 34076232 DOI: 10.1093/jalm/jfab039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/05/2021] [Indexed: 01/01/2023]
Abstract
Identifying women with preterm labor who will go on to deliver prematurely is crucial to improving outcomes for mother and baby and for saving healthcare resources. Even among those with symptoms, the number of women who deliver preterm is low, and thus the low positive predictive value (PPV) and high negative predictive value (NPV) associated with available biomarkers does not substantially reduce the uncertainty of the clinical diagnosis. While there is some promise in the use of fetal fibronectin (fFN), interleukin 6 (IL-6), or placental alpha microglobulin 1 (PAMG-1) for predicting preterm birth (PTB), their use is unlikely to provide considerable clinical value in populations with a low prevalence. To provide real clinical benefit, a biomarker must demonstrate a high PPV to allow identification of the minority of symptomatic women who will deliver prematurely. As none of the currently available biomarkers exhibit this performance characteristic, we do not recommend their routine clinical use in populations with a pre-test probability of PTB of <5%. Limiting biomarker testing to only high-risk women identified on the basis of cervical length or other characteristics will increase the pre-testprobability in the tested population, thereby improving PPV. PAMG-1 is associated with a higher PPV than fFN and may show clinical utility in populations with a higher pre-test probability, but further work is required to conclusively demonstrate improved outcomes in this patient group.
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Affiliation(s)
- Christopher Farnsworth
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Erin E Schuler
- Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, KY, USA
| | - Alison Woodworth
- Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, KY, USA
| | - Joely Straseski
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - E Rebecca Pschirrer
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Robert D Nerenz
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Chawanpaiboon S, Titapant V, Pooliam J. Placental α-microglobulin-1 in cervicovaginal fluid and cervical length to predict preterm birth by Thai women with symptoms of labor. ASIAN BIOMED 2021; 15:119-127. [PMID: 37551369 PMCID: PMC10388770 DOI: 10.2478/abm-2021-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Presence of placental α microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery. Objective 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. Methods 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 200/7 and 366/7 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. Results 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). Conclusions 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.
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Affiliation(s)
- Saifon Chawanpaiboon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok10700, Thailand
| | - Vitaya Titapant
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok10700, Thailand
| | - Julaporn Pooliam
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok10700, Thailand
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17
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Barinov SV, Di Renzo GC, Belinina AA, Koliado OV, Remneva OV. Clinical and biochemical markers of spontaneous preterm birth in singleton and multiple pregnancies. J Matern Fetal Neonatal Med 2021; 35:5724-5729. [PMID: 33627033 DOI: 10.1080/14767058.2021.1892064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM The aim of this study was to compare the clinical characteristics of singleton and twin pregnancies that resulted in spontaneous preterm births (sPTB) and to evaluate the prognostic value of phosphorylated insulin-like growth factor binding protein-1 (phIGFB-1) and placental alpha macroglobulin-1(PAMG-1) for sPTB prediction in symptomatic women. PATIENTS AND METHODS The study included 420 women and included two parts. Firstly, we performed a retrospective cohort study comparing pregnancy and neonatal outcomes in 170 women with singleton pregnancies and spontaneous preterm birth before 37 weeks of gestation with 150 women with twin pregnancies who delivered at the same gestational age. In order to obtain the link between clinical and biochemical predictors of preterm labor we organized the second part of the research. The second part was a prospective observational study in 100 women with singleton and twin pregnancies between 24 and 33 + 6 weeks of gestation and symptoms of threatening preterm labor and intact membranes. We assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for phIGFBP-1 and PAMG-1 in terms of sPTB within 7 days and 14 days after testing. RESULTS The rate of preterm premature rupture of membranes was higher in singleton pregnancies (67.1 versus 42.8%, p = 0.034). Cervical shortening in multiples was diagnosed at an earlier mean gestational age than in singleton pregnancies (30.1 ± 4.3 versus 35.9 ± 3.1 weeks, p = 0.013). In the singleton pregnancies group, the rate of microbial cervical colonization and the rate of bacterial vaginosis were significantly higher than in twin pregnancies (49.4 versus 15.3%, p < 0.001; 32.9 versus 12.0%, p = 0.007, respectively). Premature twins had a longer oxygen dependency period, while the singletons were more predisposed to infectious morbidity. The study showed low sensitivity of phIGFBP-1 for sPTB, while the sensitivity of the PAMG-1 test was higher (sensitivity 60% and 90% within 7 days after testing and 50 versus 75% within 14 days after testing). Both tests showed a high NPV for sPTB (93.3% for phIGFBP-1 versus 98.9% for PAMG-1). The NPV for preterm labor in twins was also high for both tests (93% for phIGFBP-1 and 96% for PAMG-1). CONCLUSION Cervical shortening is the main risk factor of sPTB in women with twin pregnancies; sPTB among singletons is associated with ascendent infection, involving fetal membranes. The PAMG-1 test showed high PPV and NPV for sPTB in symptomatic women and could be a reliable prognostic tool in clinical obstetrics. High NPV was observed for phIGFBP-1 and PAMG-1 in twin pregnancies.
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Affiliation(s)
- Sergey V Barinov
- Federal State Budgetary Educational Institution for Higher Education, Omsk State Medical University Ministry of Public Health, Omsk, Russian Federation
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology and Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | | | - Olga V Koliado
- Altai Regional State Clinical Perinatal Centre, Barnaul, Russia
| | - Olga V Remneva
- Federal State Budgetary Educational Institution of Higher Education, Altai State Medical University of Ministry of Health of Russian Federation, Barnaul, Russia
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18
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Dochez V, Ducarme G, Gueudry P, Joueidi Y, Boivin M, Boussamet L, Pelerin H, Le Thuaut A, Lamoureux Z, Riche VP, Winer N, Thubert T, Marie E. Methods of detection and prevention of preterm labour and the PAMG-1 detection test: a review. J Perinat Med 2021; 49:119-126. [PMID: 33001855 DOI: 10.1515/jpm-2020-0289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Preterm labour is the leading cause of hospitalization during pregnancy. In France, it results in more than 60,000 births before 37 weeks of gestation every year. Recent studies suggest that detection of placental α-microglobulin-1 (PAMG-1) in vaginal secretions among women presenting symptoms of preterm labour with intact membranes has good predictive value for the onset of spontaneous preterm delivery within 7 days. The test is especially interesting, in that the repetition of antenatal corticosteroids for foetal lung maturation is no longer recommended in France and the effect of the initial administration is most beneficial in the 24 h to 7 days afterwards. METHODS We included all studies listed in PubMed and clinicaltrials.gov with the terms "PAMG-1" and either "preterm labor" or "preterm labour", while excluding all studies on the subject of "rupture of the membranes" from 2000 through 2017. Ten studies were thus included. RESULTS In women who had both the PAMG-1 and foetal fibronectin test, the PAMG-1 test was statistically superior to the measurement of cervical length for positive predictive value (p<0.0074), negative predictive value (p=0.0169) and specificity (p<0.001) for the prediction of spontaneous preterm delivery within 7 days. CONCLUSIONS The use of PAMG-1 may make it possible to target the women at risk with a shortened cervix on ultrasound (<25 mm) those with an imminent preterm delivery and therefore to adapt management, especially the administration of antenatal corticosteroid therapy.
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Affiliation(s)
- Vincent Dochez
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France
| | - Guillaume Ducarme
- Service de Gynécologie-Obstétrique, CHD Vendée, La Roche sur Yon, France
| | - Pauline Gueudry
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France
| | - Yolaine Joueidi
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France
| | - Marion Boivin
- Centre d'Investigation Clinique CIC FEA, CHU de Nantes, Nantes, France
| | - Louise Boussamet
- Centre d'Investigation Clinique CIC FEA, CHU de Nantes, Nantes, France
| | - Hélène Pelerin
- Unité de Recherche Clinique URC, CHD Vendée, La Roche sur Yon, France
| | - Aurélie Le Thuaut
- Plateforme de Statistiques - Direction de la Recherche, CHU de Nantes, Nantes, France
| | - Zeineb Lamoureux
- Coordination Cellule Recherche Non Interventionnelle - Direction de la Recherche, CHU de Nantes, Nantes, France
| | - Valéry-Pierre Riche
- Cellule Innovation - Département Partenariat et Innovation - Direction de la Recherche, CHU de Nantes, Nantes, France
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France
| | - Emilie Marie
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France
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Rouholamin S, Razavi M, Rezaeinejad M, Sepidarkish M. A diagnostic profile on the PartoSure test. Expert Rev Mol Diagn 2020; 20:1163-1170. [PMID: 33175636 DOI: 10.1080/14737159.2020.1848549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Preterm birth (PTB) is common, occurring in over 10% of all live births globally, and is increasing worldwide. The limitations of traditional biomarkers of PTB, such as fetal fibronectin (fFN) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as placental alpha macroglobulin-1 (PAMG-1); PartoSure, has the potential to improve disease monitoring and the best interventions. Areas covered: The present expert opinion evaluates the utility and limitations of PAMG-1; PartoSure as a biomarker for PTB in light of the current literature. Expert opinion: Although fFN, phIGFBP-1 and PAMG-1; PartoSure test had similar negative predictive value (NPV) and negative likelihood ratio (LR-), the PAMG-1; PartoSure test had the highest specificity, positive predictive value (PPV), and positive likelihood ratio (LR+) across all at-risk pregnant women. Although findings of this review may be encouraging, the PartoSure test should not be interpreted as absolute evidence for prediction of PTB. The PartoSure test result should always be used in conjunction with information available from the clinical evaluation of the pregnant woman and other diagnostic procedures such as cervical examination, assessment of uterine activity, and evaluation of other risk factors.
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Affiliation(s)
- Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Maryam Razavi
- Pregnancy Health Research Center, Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences , Zahedan, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences , Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences , Babol, Iran
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20
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Gokce A, Kalafat E, Sukur YE, Altinboga O, Soylemez F. Role of cervical length and placental alpha microglobulin-1 to predict preterm birth. J Matern Fetal Neonatal Med 2020; 35:3388-3392. [PMID: 33225786 DOI: 10.1080/14767058.2020.1818222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION 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. OBJECTIVE 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Ali Gokce
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Erkan Kalafat
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Yavuz Emre Sukur
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Orhan Altinboga
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Feride Soylemez
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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21
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Varley-Campbell J, Mújica-Mota R, Coelho H, Ocean N, Barnish M, Packman D, Dodman S, Cooper C, Snowsill T, Kay T, Liversedge N, Parr M, Knight L, Hyde C, Shennan A, Hoyle M. Three biomarker tests to help diagnose preterm labour: a systematic review and economic evaluation. Health Technol Assess 2020; 23:1-226. [PMID: 30917097 DOI: 10.3310/hta23130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Preterm birth may result in short- and long-term health problems for the child. Accurate diagnoses of preterm births could prevent unnecessary (or ensure appropriate) admissions into hospitals or transfers to specialist units. OBJECTIVES The purpose of this report is to assess the test accuracy, clinical effectiveness and cost-effectiveness of the diagnostic tests PartoSure™ (Parsagen Diagnostics Inc., Boston, MA, USA), Actim® Partus (Medix Biochemica, Espoo, Finland) and the Rapid Fetal Fibronectin (fFN)® 10Q Cassette Kit (Hologic, Inc., Marlborough, MA, USA) at thresholds ≠50 ng/ml [quantitative fFN (qfFN)] for women presenting with signs and symptoms of preterm labour relative to fFN at 50 ng/ml. METHODS Systematic reviews of the published literature were conducted for diagnostic test accuracy (DTA) studies of PartoSure, Actim Partus and qfFN for predicting preterm birth, the clinical effectiveness following treatment decisions informed by test results and economic evaluations of the tests. A model-based economic evaluation was also conducted to extrapolate long-term outcomes from the results of the diagnostic tests. The model followed the structure of the model that informed the 2015 National Institute for Health and Care Excellence guidelines on preterm labour diagnosis and treatment, but with antenatal steroids use, as opposed to tocolysis, driving health outcomes. RESULTS Twenty studies were identified evaluating DTA against the reference standard of delivery within 7 days and seven studies were identified evaluating DTA against the reference standard of delivery within 48 hours. Two studies assessed two of the index tests within the same population. One study demonstrated that depending on the threshold used, qfFN was more or less accurate than Actim Partus, whereas the other indicated little difference between PartoSure and Actim Partus. No study assessing qfFN and PartoSure in the same population was identified. The test accuracy results from the other included studies revealed a high level of uncertainty, primarily attributable to substantial methodological, clinical and statistical heterogeneity between studies. No study compared all three tests simultaneously. No clinical effectiveness studies evaluating any of the three biomarker tests were identified. One partial economic evaluation was identified for predicting preterm birth. It assessed the number needed to treat to prevent a respiratory distress syndrome case with a 'treat-all' strategy, relative to testing with qualitative fFN. Because of the lack of data, our de novo model involved the assumption that management of pregnant women fully adhered to the results of the tests. In the base-case analysis for a woman at 30 weeks' gestation, Actim Partus had lower health-care costs and fewer quality-adjusted life-years (QALYs) than qfFN at 50 ng/ml, reducing costs at a rate of £56,030 per QALY lost compared with qfFN at 50 ng/ml. PartoSure is less costly than Actim Partus while being equally effective, but this is based on diagnostic accuracy data from a small study. Treatment with qfFN at 200 ng/ml and 500 ng/ml resulted in lower cost savings per QALY lost relative to fFN at 50 ng/ml than treatment with Actim Partus. In contrast, qfFN at 10 ng/ml increased QALYs, by 0.002, and had a cost per QALY gained of £140,267 relative to fFN at 50 ng/ml. Similar qualitative results were obtained for women presenting at different gestational ages. CONCLUSION There is a high degree of uncertainty surrounding the test accuracy and cost-effectiveness results. We are aware of four ongoing UK trials, two of which plan to enrol > 1000 participants. The results of these trials may significantly alter the findings presented here. STUDY REGISTRATION The study is registered as PROSPERO CRD42017072696. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rubén Mújica-Mota
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Neel Ocean
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Max Barnish
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - David Packman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sophie Dodman
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK.,Health Economics Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tracey Kay
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Michelle Parr
- Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Lisa Knight
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
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22
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Kashanian M, Eshraghi N, Rahimi M, Sheikhansari N. Evaluation of placental alpha microglobulin-1(PAMG1) accuracy for prediction of preterm delivery in women with the symptoms of spontaneous preterm labor; a comparison with cervical length and number of contractions. J Matern Fetal Neonatal Med 2020; 35:534-540. [PMID: 32068450 DOI: 10.1080/14767058.2020.1728246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction: 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.Objective: 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.Materials and methods: 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.Results: 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 (p < .0001), ≤7 days (p < .0001), and before 37 weeks (p < .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.Conclusion: 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.
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Affiliation(s)
- Maryam Kashanian
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Nooshin Eshraghi
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Maryam Rahimi
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
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23
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Pirjani R, Moini A, Almasi-Hashiani A, Farid Mojtahedi M, Vesali S, Hosseini L, Sepidarkish M. Placental alpha microglobulin-1 (PartoSure) test for the prediction of preterm birth: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:3445-3457. [PMID: 31736399 DOI: 10.1080/14767058.2019.1685962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the accuracy of the placental alpha microglobulin-1 (PAMG-1) to predict preterm birth (PB) in women with symptoms of PB through use of formal methods for systematic reviews and meta-analytic techniques. METHODS We performed a comprehensive search of medical bibliographic databases to identify observational studies that reported on the predictive accuracy of PAMG-1 for PB. Two investigators independently assessed studies, assessed quality of studies, and extracted data. Summary receiver operating characteristic (SROC) curves, pooled sensitivities, specificities, likelihood ratios (LR), and diagnostic odds ratio (DOR) were generated. RESULTS Seventeen studies involving 2590 women met the inclusion criteria. Meta-analysis of 15 studies (including 1906 women) revealed a pooled sensitivity of 66.2% (95% CI: 59.1, 72.7) and specificity of 96.1% (95% CI: 95.1, 97.0) with the SROC equal to 0.97 (95% CI: 0.95, 0.98) for prediction of delivery within 7 d of testing. The summary estimates were 15.26 (95% CI: 11.80, 19.75) for LR + and 0.31 (95% CI: 0.17, 0.55) for LR - for prediction of delivery within 7 d of testing. Pooled estimate of DOR for predicting delivery within 7 d of testing was 55.13 (95% CI: 35.32, 86.06). The sensitivity, specificity and the SROC of PAMG-1 pooled from 10 studies (including 1508 women) for prediction of delivery within 14 d of testing were 64.4% (95% CI: 56.8, 71.5), 96.9% (95% CI: 95.8, 97.7) and 0.97 (95% CI: 0.95, 0.98). The overall pooled LR + and LR - of PAMG-1 for predicting delivery within 14 d of testing among the included studies were 16.72 (95% CI: 12.03, 23.23) and 0.42.1 (95% CI: 0.31, 0.56), respectively. The pooled DOR of the PAMG-1 for prediction delivery within 14 d of testing was equal to 44.65 (95% CI: 26.30, 75.78). CONCLUSION Cervical PAMG-1 had a high accuracy to predict PB within 7 and 14 d of testing in symptomatic pregnant women.
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Affiliation(s)
- Reihaneh Pirjani
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Farid Mojtahedi
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Vesali
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ladan Hosseini
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
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24
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Dawes LK, Prentice LR, Huang Y, Groom KM. The Biomarkers for Preterm Birth Study-A prospective observational study comparing the impact of vaginal biomarkers on clinical practice when used in women with symptoms of preterm labor. Acta Obstet Gynecol Scand 2019; 99:249-258. [PMID: 31519040 DOI: 10.1111/aogs.13729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aims to compare the use of qualitative fetal fibronectin, quantitative fetal fibronectin, and placental α-microglobulin-1 in women with symptoms of preterm labor, to evaluate which vaginal biomarker performs the best in clinical practice. MATERIAL AND METHODS This prospective observational study included women who presented with symptoms of preterm labor at 24+0 to 34+0 weeks of gestation at a large tertiary maternity hospital in Auckland, New Zealand. Women were managed according to hospital guidelines using qualitative fetal fibronectin. Quantitative fetal fibronectin and placental α-microglobulin-1 tests were also taken, with clinicians blinded to the results. Management and delivery outcomes were collected from clinical records. The primary outcome was the rate of antenatal hospital admission. Analysis was performed according to predefined management protocols for each of the tests. RESULTS A total of 128 women had all three biomarkers tests taken. Spontaneous preterm birth rates were 7/128 (5.5%) ≤34+0 weeks and 20/128 (15.6%) <37+0 weeks of gestation; 5/128 (3.9%) delivered within 7 days of testing. Positive results were recorded in 28 qualitative fetal fibronectin tests, 25 quantitative fetal fibronectin tests with 11 ≥200 ng/mL, and 16 placental α-microglobulin-1 tests. The use of quantitative fetal fibronectin or placental α-microglobulin-1 would have lowered antenatal admission rates: 27/128 (21.1%) for qualitative fetal fibronectin, 11/128 (8.6%) for quantitative fetal fibronectin (admission threshold ≥200 ng/mL), and 15/128 (11.7%) for placental α-microglobulin-1. No additional women with quantitative fetal fibronectin <200 ng/mL delivered within 7 days or missed corticosteroids compared with standard care (qualitative fetal fibronectin); however, an additional 3 cases had a false-negative placental α-microglobulin-1 and clinical care may have been compromised (no antenatal corticosteroids or admission). CONCLUSIONS The use of quantitative fetal fibronectin (admission threshold ≥200 ng/mL) has the potential to reduce the rate of antenatal admissions for women with symptoms of preterm labor without compromising use of antenatal interventions that improve outcomes for babies born preterm.
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Affiliation(s)
- Lisa K Dawes
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Lucy R Prentice
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Ying Huang
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Katie M Groom
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
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25
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Bovbjerg ML. Current Resources for Evidence-Based Practice, March 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:230-248. [PMID: 30735623 DOI: 10.1016/j.jogn.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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26
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Abstract
Preterm birth, defined as birth occurring prior to 37 weeks gestation, is a serious obstetric problem accounting for 11% of pregnancies worldwide. It is associated with significant neonatal morbidity and mortality. Predictive tests for preterm birth are incredibly important, given the huge personal, economic, and health impacts of preterm birth. They can provide reassurance for women who are unlikely to deliver early, but they are also important for highlighting those women at higher risk of premature delivery so that we can offer prophylactic interventions and help guide antenatal management decisions. Unfortunately, there is unlikely to be a single test for predicting preterm birth, but a combination of tests is likely to improve clinical prediction. This review explores the clinical utility of the currently marketed predictive tests for preterm birth in both singleton and multiple pregnancies, as well as discussing novel predictive tests that may be useful in the future.
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Affiliation(s)
- Natalie Suff
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK.
| | - Lisa Story
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK; Centre for the Developing Brain, King's College London, St Thomas' Hospital, London, UK
| | - Andrew Shennan
- Department of Women's Health, King's College London, St Thomas' Hospital, London, UK
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27
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Faron G, Gucciardo L, Balepa L. Reply: the true clinical utility of quantitative fetal fibronectin. J Matern Fetal Neonatal Med 2019; 33:524-525. [PMID: 30409063 DOI: 10.1080/14767058.2018.1546567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- G Faron
- Department of Obstetrics and Prenatal Medicine, UZ Brussel, Vrije Universiteit Brussel, Jette, Belgium
| | - L Gucciardo
- Department of Obstetrics and Prenatal Medicine, UZ Brussel, Vrije Universiteit Brussel, Jette, Belgium
| | - L Balepa
- Department of Obstetrics and Prenatal Medicine, UZ Brussel, Vrije Universiteit Brussel, Jette, Belgium
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28
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Amylidi-Mohr S, Mueller M. [Preterm Birth Screening: What Does Really Make Sense?]. PRAXIS 2019; 108:53-57. [PMID: 30621535 DOI: 10.1024/1661-8157/a003137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Preterm Birth Screening: What Does Really Make Sense? Abstract. Spontaneous preterm birth is a syndrome triggered by multiple mechanisms. In view of the pathophysiological heterogeneity of preterm birth, a single biomarker cannot show the required high negative and positive predictive values. From a clinical point of view, anamnesis, sonographic measurement of cervical length, and placental alpha-microglobulin-1 (PAMG-1) testing from cervico-vaginal secretion are established. Further prospective, large-scale longitudinal studies must validate the combined use of new biomarkers.
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Affiliation(s)
- Sofia Amylidi-Mohr
- 1 Geburtshilfe und Feto-Maternale Medizin, Universitätsklinik für Frauenheilkunde, Inselspital Bern
| | - Martin Mueller
- 1 Geburtshilfe und Feto-Maternale Medizin, Universitätsklinik für Frauenheilkunde, Inselspital Bern
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, USA
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29
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Nikolova T, Uotila J, Nikolova N, Bolotskikh VM, Borisova VY, Di Renzo GC. Prediction of spontaneous preterm delivery in women presenting with premature labor: a comparison of placenta alpha microglobulin-1, phosphorylated insulin-like growth factor binding protein-1, and cervical length. Am J Obstet Gynecol 2018; 219:610.e1-610.e9. [PMID: 30240653 DOI: 10.1016/j.ajog.2018.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Placental alpha microglobulin-1 and phosphorylated insulin-like growth factor-binding protein-1 have been studied in patients at risk for preterm birth with signs and symptoms of preterm labor. However, a direct comparison between these 2 biomarkers, alone or in combination with cervical length measurement with an adequate sample size, has been lacking to date. OBJECTIVE The purpose of this study was to compare the placental alpha microglobulin-1 test and the phosphorylated insulin-like growth factor-binding protein-1 test alone and in combination with cervical length measurement for the prediction of imminent spontaneous preterm birth of testing in pregnant women with symptoms of preterm labor in a tertiary care setting. STUDY DESIGN Four hundred three patients with intact amniotic membranes and cervical dilation ≤3 cm, without recent intercourse or cerclage, between gestational weeks of 20+0 and 36+6 were recruited prospectively from 3 international centers. Placental alpha microglobulin-1 and phosphorylated insulin-like growth factor-binding protein-1 tests were conducted before cervical length measurement via transvaginal ultrasound scanning. Caregivers were blinded to the biomarker test results. Medically indicated deliveries within 14 days of testing were excluded. Standard performance statistics with 95% confidence intervals were calculated and compared based on pairwise estimates from a generalized model. RESULTS Of 403 subjects who were enrolled in the study cohort, 94% (383/403 women) met the inclusion criteria. Median gestational age and cervical length at presentation were 30+5 weeks and 27 mm, respectively; 6.8% women (26/383 women) had spontaneous birth ≤7 days from testing. The placental alpha microglobulin-1 test was positive in 7.8% of the women (30/383 women); the phosphorylated insulin-like growth factor-binding protein-1 test was positive in 29.5% women (113/383 women). Positive predictive value for placental alpha microglobulin-1, phosphorylated insulin-like growth factor-binding protein-1, and cervical length <25 mm for the prediction of spontaneous preterm birth in the overall cohort was 60.0% (18/30 women), 18.6% (21/113 women), 11.8% (18/152 women), respectively. The negative predictive value was 97.7% (345/353 women), 98.2% (265/270 women), 96.5% (223/231 women), respectively. The prevalence of spontaneous preterm birth in this group was 6.8% (26/383 women). The positive likelihood ratios were 20.6, 3.1, and 1.8, respectively. The negative likelihood ratio were 0.3, 0.3, and 0.5, respectively. Positive predictive values for placental alpha microglobulin-1 and phosphorylated insulin-like growth factor-binding protein-1 tests in patients with cervical length shortening of 15-30 mm for the prediction of spontaneous preterm birth were 60.9% (14/23 women) and 28.1% (16/57 women), respectively. The negative predictive values were 97.1% (168/173 women) and 97.8% (136/139 women), respectively. The prevalence of spontaneous preterm birth in the 15-30 mm cohort was 9.7% (19/196 women). The positive likelihood ratios were 14.5 and 3.6, respectively. The negative likelihood ratios were 0.3 and 0.2, respectively. CONCLUSION Placental alpha microglobulin-1 is significantly more specific than phosphorylated insulin-like growth factor-binding protein-1 for the prediction of spontaneous preterm birth ≤7 days (P<.0001), whereas both tests have comparable sensitivity. In patients with cervical length 15-30 mm, although placental alpha microglobulin-1 has a significantly higher positive predictive value and specificity compared with phosphorylated insulin-like growth factor-binding protein-1 for the prediction of spontaneous preterm birth at ≤7 days (P<.01), both tests have a comparable sensitivity and negative predictive value. In conclusion, placental alpha microglobulin-1 is a better predictor of imminent spontaneous preterm birth when compared with phosphorylated insulin-like growth factor-binding protein-1 alone or in combination with cervical length measurement. In patients with shortening of cervical length of 15-30 mm, the placental alpha microglobulin-1 test is a significantly better predictor of imminent spontaneous preterm birth within 7 days of testing than is phosphorylated insulin-like growth factor-binding protein-1.
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Affiliation(s)
- Tanja Nikolova
- University Clinic of Obstetrics and Gynecology, Skopje, Republic of Macedonia.
| | - Jukka Uotila
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Natasha Nikolova
- University Clinic of Obstetrics and Gynecology, Skopje, Republic of Macedonia
| | - Vyacheslav M Bolotskikh
- Ott Research Institute of Obstetrics and Gynecology, North-Western Branch, Russian Academy of Medical Sciences, Saint Petersburg, Russia
| | - Vera Y Borisova
- Ott Research Institute of Obstetrics and Gynecology, North-Western Branch, Russian Academy of Medical Sciences, Saint Petersburg, Russia
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
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Melchor JC, Khalil A, Wing D, Schleussner E, Surbek D. Prediction of preterm delivery in symptomatic women using PAMG-1, fetal fibronectin and phIGFBP-1 tests: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:442-451. [PMID: 29920825 DOI: 10.1002/uog.19119] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the accuracy of placental alpha microglobulin-1 (PAMG-1), fetal fibronectin (fFN) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) tests in predicting spontaneous preterm birth (sPTB) within 7 days of testing in women with symptoms of preterm labor, through a systematic review and meta-analysis of the literature. The test performance of each biomarker was also assessed according to pretest probability of sPTB ≤ 7 days. METHODS The Cochrane, MEDLINE, PubMed and ResearchGate bibliographic databases were searched from inception until October 2017. Cohort studies that reported on the predictive accuracy of PAMG-1, fFN and phIGFBP-1 for the prediction of sPTB within 7 days of testing in women with symptoms of preterm labor were included. Summary receiver-operating characteristics (ROC) curves and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive (LR+) and negative (LR-) likelihood ratios were generated using indirect methods for the calculation of pooled effect sizes with a bivariate linear mixed model for the logit of sensitivity and specificity, with each diagnostic test as a covariate, as described by the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. RESULTS Bivariate mixed model pooled sensitivity of PAMG-1, fFN and phIGFBP-1 for the prediction of sPTB ≤ 7 days was 76% (95% CI, 57-89%), 58% (95% CI, 47-68%) and 93% (95% CI, 88-96%), respectively; pooled specificity was 97% (95% CI, 95-98%), 84% (95% CI, 81-87%) and 76% (95% CI, 70-80%) respectively; pooled PPV was 76.3% (95% CI, 69-84%) (P < 0.05), 34.1% (95% CI, 29-39%) and 35.2% (95% CI, 31-40%), respectively; pooled NPV was 96.6% (95% CI, 94-99%), 93.3% (95% CI, 92-95%) and 98.7% (95% CI, 98-99%), respectively; pooled LR+ was 22.51 (95% CI, 15.09-33.60) (P < 0.05), 3.63 (95% CI, 2.93-4.50) and 3.80 (95% CI, 3.11-4.66), respectively; and pooled LR- was 0.24 (95% CI, 0.12-0.48) (P < 0.05), 0.50 (95% CI, 0.39-0.64) and 0.09 (95% CI, 0.05-0.16), respectively. The areas under the ROC curves for PAMG-1, fFN and phIGFBP-1 for sPTB ≤ 7 days were 0.961, 0.874 and 0.801, respectively. CONCLUSIONS In the prediction of sPTB within 7 days of testing in women with signs and symptoms of preterm labor, the PPV of PAMG-1 was significantly higher than that of phIGFBP-1 or fFN. Other diagnostic accuracy measures did not differ between the three biomarker tests. As prevalence affects the predictive performance of a diagnostic test, use of a highly specific assay for a lower-prevalence syndrome such as sPTB may optimize management. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J C Melchor
- Cruces University Hospital (UPV/EHU), BioCruces Health Research Institute, Vizcaya, Spain
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - D Wing
- Formerly of the University of California, Irvine, Orange, CA, USA
| | - E Schleussner
- Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - D Surbek
- Department of Obstetrics and Gynecology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
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Shennan AH. Prediction and prevention of preterm birth: a quagmire of evidence. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:569-570. [PMID: 29727066 DOI: 10.1002/uog.19063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, FoLSM, Kings College London, London, UK
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