Evaluation of risk factors and modern possibilities for prediction of preterm labour
DOI:
https://doi.org/10.14739/2310-1210.2019.6.186500Keywords:
preterm birth, progesterone, insulin, cortisol, prognosisAbstract
The aim is based on the comprehensive examination of pregnant women to determine the risk factors for preterm labor and develop criteria for its prediction.Materials and methods. In a prospective opened study took part 63 patients at 22–34 weeks of gestation. The study was carried out on the basis of PI “Regional Perinatal Center” ZRC, which is the clinical base of the Department of Obstetrics and Gynecology, ZSMU. The average age of pregnant women was 27.1 ± 0.8 (M ± SD) years. Pregnant women were divided into two groups, depending on the gestation period course. Thus, group I included 44 pregnant women who had TPL (threatened preterm labor), and group II – 19 patients with normal course of pregnancy.In the first day, body mass index was determined and laboratory examinations (progesterone, insulin and cortisol level) were performed.Results. According to the ROC analysis, we obtained the following distribution points: the age of pregnant women over 35 years (sensitivity 33.3 %, specificity 96.1 %), the area under the ROC curve of 0.542 (95 % CI 0.411–0.668, P = 0.6953); body mass index (BMI) ≤22.95 kg/m² (sensitivity 66.7 %, specificity 84.3 %), the area under the ROC curve 0.694 (95 % CI 0.566–0.804, P = 0.01); insulin >31.36 μMe/ml (sensitivity 41.7 %, specificity 90.2 %), the area under the ROC curve 0.505 (95 % CI 0.376–0.633, P = 0.96); cortisol ≤609.7 ng/ml (75 % sensitivity, 55 % specificity), the area under the ROC curve of 0.694 (95 % CI 0.518–0.765, P = 0.07); progesterone <247.8 ng/ml (sensitivity 41.7 %, specificity 88.2 %), the area under the ROC curve 0.579 (95% CI 0.448–0.703, P = 0.4).Conclusions. The results of the conducted research indicate that multivariate logistic regression analysis allows determining the risk factors of preterm labor. Among the established prognostic markers for spontaneous preterm birth, the most comprehensive information is the complex assessment of age, BMI and hormonal profile. The findings suggest that dependent risk factors for preterm birth include: the level of progesterone lower than 139.5 ng/ml, cortisol less than 577.9 ng/ml, BMI less than 24 kg/m2 and maternal age of over 25 years. Independent factors should include the maternal age of over 35 years, the level of insulin above 31.36 ng/ml and progesterone less than 247.8 ng/ml. Considering the study results, high specificity and sensitivity of the proposed multivariate models, it would be appropriate to include measurements of progesterone, insulin and cortisol levels in the standard examination complex for pregnant women from 22 to 34 weeks of gestation. It will enable the identification of a risk group for preterm labor and implementation of timely prevention.
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