Prediction of spontaneous preterm delivery in women with threatened preterm labour: a prospective cohort study of multiple proteins in maternal serum

Authors

  • P Tsiartas,

    1. Department of Obstetrics and Gynaecology, Papageorgiou University Hospital, Thessaloniki, Greece
    2. Department of Obstetrics and Gynaecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
    Search for more papers by this author
  • RM Holst,

    1. Department of Obstetrics and Gynaecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
    Search for more papers by this author
  • UB Wennerholm,

    1. Department of Obstetrics and Gynaecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
    Search for more papers by this author
  • H Hagberg,

    1. Department of Obstetrics and Gynaecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
    2. Institute of Reproductive and Developmental Biology, Hammersmith Campus, Imperial College, London, UK
    Search for more papers by this author
  • DM Hougaard,

    1. Department of Clinical Biochemistry and Immunology, Statens Serum Institute, Copenhagen, Denmark
    Search for more papers by this author
  • K Skogstrand,

    1. Department of Clinical Biochemistry and Immunology, Statens Serum Institute, Copenhagen, Denmark
    Search for more papers by this author
  • BD Pearce,

    1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
    Search for more papers by this author
  • P Thorsen,

    1. Department of Obstetrics and Gynaecology, Lillebaelt Hospital, Kolding, Denmark
    Search for more papers by this author
  • M Kacerovsky,

    1. Department of Obstetrics and Gynaecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
    2. Department of Obstetrics and Gynaecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Kralove, Czech Republic
    Search for more papers by this author
  • B Jacobsson

    1. Department of Obstetrics and Gynaecology, Institute for Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
    2. Institute of Public Health, Oslo, Norway
    Search for more papers by this author

Dr P Tsiartas, Department of Obstetrics and Gynaecology, Papageorgiou University Hospital, Ring Road, Nea Efkarpia, Thessaloniki 56429, Greece. Email tsiartaspanos@gmail.com

Abstract

Please cite this paper as: Tsiartas P, Holst R, Wennerholm U, Hagberg H, Hougaard D, Skogstrand K, Pearce B, Thorsen P, Kacerovsky M, Jacobsson B. Prediction of spontaneous preterm delivery in women with threatened preterm labour: a prospective cohort study of multiple proteins in maternal serum. BJOG 2012;119:866–873.

Objective  To analyse whether specific proteins in maternal serum and cervical length, alone or in combination, can predict the likelihood that women with intact membranes with threatened preterm labour will deliver spontaneously within 7 days of sampling.

Design  Cohort study.

Setting  Sahlgrenska University Hospital, Gothenburg, Sweden.

Population  Women at between 22 and 33 weeks of gestation with threatened preterm labour (n = 142) admitted to the Sahlgrenska University Hospital, Gothenburg, Sweden, in 1995–2005.

Methods  Maternal serum was tested for 27 proteins using multiplex xMAP technology. Individual levels of each protein were compared, and calculations were performed to investigate potential associations between different proteins, cervical length and spontaneous preterm delivery. Receiver operating characteristic curves were used to find the best cut-off values for continuous variables in relation to spontaneous preterm delivery within 7 days of sampling. Prediction models were created based on a stepwise logistic regression using binary variables.

Main outcome measure  Spontaneous preterm delivery within 7 days.

Results  In order to determine the best prediction model, we analysed models of serum proteins alone, cervical length alone, and the combination of serum proteins and cervical length. We found one multivariable combined model through the data analysis that more accurately predicted spontaneous preterm delivery within 7 days. This model was based on serum interleukin-10 (IL-10) levels, serum RANTES levels and cervical length (sensitivity 74%, specificity 87%, positive predictive value 76%, negative predictive value 86%, likelihood ratio 5.8 and area under the curve 0.88).

Conclusions  A combination of maternal serum proteins and cervical length constituted the best prediction model, and would help determine whether women with threatened preterm labour are likely to deliver within 7 days of measurement.

Ancillary