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Minerva Ginecologica 2018 October;70(5):635-40

DOI: 10.23736/S0026-4784.18.04243-0


language: Italian

New methods for preterm birth prediction: the PAMG-1 test

Laura DI FABRIZIO 1, Irene GIARDINA 1, Irene CETIN 2, Mariarosaria DI TOMMASO 3, Andrea CIAVATTINI 4, Mariavittoria LOCCI 5, Fabio FACCHINETTI 6, Marina ZONCA 7, Gian Carlo DI RENZO 1

1 Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy; 2 Department of Mother and Child Health, Luigi Sacco Hospital, Giorgio Pardi Center for Fetal Research, Milan, Italy; 3 Department of Health Sciences, University of Florence, Florence, Italy; 4 Division of Gynecology, Department of Women’s Health Sciences, Polytechnic University of Marche, Ancona, Italy; 5 Department of Obstetrics and Gynecology, Federico II University, Naples, Italy; 6 Department of Mother and Child Health, University of Modena and Reggio Emilia, Modena, Italy; 7 Department of Surgical Sciences, Obstetrics, and Gynecology, University of Turin, Sant’Anna University Hospital, Turin, Italy

BACKGROUND: The aim of this study was to assess the efficacy of PAMG-1 test (placental alpha microglobulin-1) in cervicovaginal secretions collected immediately following transvaginal ultrasound (TVUS) of women with signs and symptoms of preterm labor (PTL), clinically intact membranes and cervical length between 15 and 30 mm for the prediction of imminent spontaneous delivery (within 7 days of testing), as well as delivery <34 weeks of gestation.
METHODS: Performing PAMG-1 test in 79 women with singleton pregnancy (240/7 -336/7 weeks’ gestation) reporting signs and symptoms indicative of PTL and cervical length <30 mm.
RESULTS: For PTB prediction risk within 7 days of testing in pregnant women with cervicale length between 15-30 mm sensitivity is 100% and specificity is 94%. Positive predictive value (PPV) is 77% and negative predictive value (NPV) is 100%. For delivery prediction <34 weeks of gestation sensitivity decreased from 100% to 67% and specificity from 94% to 89%, PPV is 55% and NPV 93%.
CONCLUSIONS: The inaccuracy of traditional methods, including biophysical tests, biochemical markers, or the combination of both, for assessing the risk of spontaneous preterm birth in patients presenting with symptoms of PTL often leads to unnecessary admission and administration of corticosteroids and tocolytics. The PAMG-1 test demonstrated high efficacy in identifying women at risk of imminent PTL within 7 days of testing, despite being performed immediately after TVUS. High NPV can prevent improper admission and unnecessary therapies for mother and fetus.

KEY WORDS: Premature obstetric labor - Human IGFBP1 protein - Premature birth - Cervical length measurement

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