BIOMARKERS AND CERVICAL LENGTH TO PREDICT SPONTANEOUS PRETERM BIRTH IN HIGH-RISK WOMEN

Preterm birth still remains a major cause of perinatal morbidity and mortality, and its rate has not declined over the last two decades despite the improvement in perinatal management. The aim of the study is to assess the use of fetal fibronectin (fFN) testing and cervical length (CL) measurement to predict preterm delivery. This is a prospective study of patients admitted between November 2009 and June 2011 to the University Obstetric Gynecologic Hospital “Mbreteresha Geraldine”, in Tirana, with the diagnosis of increased preterm uterine contractility and intact membranes between 22 and 34 weeks of gestation. Among the 249 women with complete outcome, four were excluded from the final analysis as two had assessment for fFN but no CL measurement, and another two had CL measured but no screening for fFN. Among 245 women with complete results, the mean gestational age at recruitment was 29.4 ± 2.5 weeks. Six women (9.6%) delivered within two weeks of assessment, and 14 (22.5%) delivered before 34 weeks. A positive fFN test resulted in a sensitivity of 83%, a specificity of 84%, a positive predictive value of 36%, and a negative predictive value of 98% for delivery within two weeks; for CL < 25 mm, these figures were 50%, 52%, 10%, and 91%, respectively. In this study, fFN screening provided the best predictive capacity. Cervical ultrasound after fFN triage is an acceptable option, depending on the resources available.