TY - JOUR
T1 - Risk factors for preterm delivery
T2 - Do they add to fetal fibronectin testing and cervical length measurement in the prediction of preterm delivery in symptomatic women?
AU - van Baaren, Gert-Jan
AU - Bruijn, Mere M. C.
AU - Vis, Jolande Y.
AU - Wilms, Femke F.
AU - Oudijk, Martijn A.
AU - Kwee, Anneke
AU - Porath, Martina M.
AU - Oei, Guid
AU - Scheepers, Hubertina C. J.
AU - Spaanderman, Marc E. A.
AU - Bloemenkamp, Kitty W. M.
AU - Haak, Monique C.
AU - Bolte, Antoinette C.
AU - Bax, Caroline J.
AU - Cornette, Jerome M. J.
AU - Duvekot, Johannes J.
AU - Bijvanck, Bas W. A. Nij
AU - van Eijc, Jim
AU - Franssen, Maureen T. M.
AU - Sollie, Krystyna M.
AU - Vandenbussche, Frank P. H. A.
AU - Woiski, Mallory
AU - Bossuyt, Patrick M. M.
AU - Opmeer, Brent C.
AU - Mol, Ben W. J.
PY - 2015/9
Y1 - 2015/9
N2 - Objective: To assess whether patient characteristics add to the fetal fibronectin test and cervical length measurement in the prediction of preterm delivery in symptomatic women.Study design: A nationwide prospective cohort study was conducted in all ten perinatal centres in the Netherlands. Women with symptoms of preterm labour between 24 and 34 weeks gestation with intact membranes were invited. In all women qualitative fibronectin testing (0.050 tig/mL cut-off) and cervical length measurement were performed. Only singleton pregnancies were included in this analysis. Logistic regression was used to construct two multivariable models to predict spontaneously delivery within 7 days: a model including cervical length and fetal fibronectin as predictors, and an extended model including all potential predictors. The models were internally validated using bootstrapping techniques. Predictive performances were assessed as the area under the receiver operator characteristic curve (AUC) and calibration plots. We compared the models' capability to identify women with a low risk to deliver within 7 days. A risk less than 5%, corresponding to the risk for women with a cervical length of at least 25 mm, was considered as low risk.Results: Seventy-three of 600 included women (12%) had delivered spontaneously within 7 days. The extended model included maternal age, parity, previous preterm delivery, vaginal bleeding, C-reactive protein, cervical length, dilatation and fibronectin status. Both models had high discriminative performances (AUC of 0.92 (95% CI 0.88-0.95) and 0.95 (95% CI 0.92-0.97) respectively). Compared to the model with fibronectin and cervical length, our extended model reclassified 38 women (6%) from low risk to high risk and 21 women (4%) from high risk to low risk. Preterm delivery within 7 days occurred once in both the reclassification groups.Conclusion: In women with symptoms of preterm labour before 34 weeks gestation, a model that integrates maternal characteristics, clinical signs and laboratory tests, did not predict delivery within 7 days better than a model with only fibronectin and cervical length. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
AB - Objective: To assess whether patient characteristics add to the fetal fibronectin test and cervical length measurement in the prediction of preterm delivery in symptomatic women.Study design: A nationwide prospective cohort study was conducted in all ten perinatal centres in the Netherlands. Women with symptoms of preterm labour between 24 and 34 weeks gestation with intact membranes were invited. In all women qualitative fibronectin testing (0.050 tig/mL cut-off) and cervical length measurement were performed. Only singleton pregnancies were included in this analysis. Logistic regression was used to construct two multivariable models to predict spontaneously delivery within 7 days: a model including cervical length and fetal fibronectin as predictors, and an extended model including all potential predictors. The models were internally validated using bootstrapping techniques. Predictive performances were assessed as the area under the receiver operator characteristic curve (AUC) and calibration plots. We compared the models' capability to identify women with a low risk to deliver within 7 days. A risk less than 5%, corresponding to the risk for women with a cervical length of at least 25 mm, was considered as low risk.Results: Seventy-three of 600 included women (12%) had delivered spontaneously within 7 days. The extended model included maternal age, parity, previous preterm delivery, vaginal bleeding, C-reactive protein, cervical length, dilatation and fibronectin status. Both models had high discriminative performances (AUC of 0.92 (95% CI 0.88-0.95) and 0.95 (95% CI 0.92-0.97) respectively). Compared to the model with fibronectin and cervical length, our extended model reclassified 38 women (6%) from low risk to high risk and 21 women (4%) from high risk to low risk. Preterm delivery within 7 days occurred once in both the reclassification groups.Conclusion: In women with symptoms of preterm labour before 34 weeks gestation, a model that integrates maternal characteristics, clinical signs and laboratory tests, did not predict delivery within 7 days better than a model with only fibronectin and cervical length. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
KW - Preterm labour
KW - Prediction
KW - Fetal fibronectin
KW - Cervical length
KW - Pregnancy
KW - ANTENATAL CORTICOSTEROIDS
KW - UTERINE CONTRACTIONS
KW - MISSING VALUES
KW - LABOR
KW - PHARMACOKINETICS
KW - NIFEDIPINE
KW - TOCOLYSIS
KW - EPIDEMIOLOGY
KW - IMPUTATION
KW - REGRESSION
U2 - 10.1016/j.ejogrb.2015.05.004
DO - 10.1016/j.ejogrb.2015.05.004
M3 - Article
SN - 0301-2115
VL - 192
SP - 79
EP - 85
JO - European journal of obstetrics gynecology and reproductive biology
JF - European journal of obstetrics gynecology and reproductive biology
ER -