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Phosphorylated IGFBP-1 in predicting successful vaginal delivery in post-term pregnancy
Abstract and Figures
Purpose:
To estimate whether phosphorylated IGFBP-1 (phIGFBP-1) in cervical secretion in term and post-term pregnancies can predict spontaneous onset of labor or vaginal delivery.
Methods:
A prospective cohort study of 167 women in singleton term and post-term pregnancies, was conducted at 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2013 and 2014. phIGFBP-1 test (Actim Partus Medix Biochemica), ultrasound cervix assessment and Bishop score were analyzed in the study group. Spontaneous onset of labor was the primary and vaginal delivery was the secondary outcome.
Results:
In 32.5 % of patients, spontaneous uterine contractions appeared. 67.5 % of women delivered vaginally, 32.5 % had cesarean section. phIGFBP-1 test predicted spontaneous onset of labor (sensitivity 0.69, specificity of 0.42) and successful vaginal delivery (0.67, 0.48). In the prediction of spontaneous delivery onset ultrasound cervical assessment and phIBFBP-1 had comparable sensitivity and in the prediction of successful vaginal birth all three tests had comparable sensitivity. The time from preinduction to spontaneous onset of delivery was significantly shorter in women with positive phIGFBP-1 test (13.65 ± 6.7 vs 20.75 ± 2.6 h; p = 0.006).
Conclusion:
A test for phIGFBP1 presence might be an additional tool for predicting both spontaneous onset of labor and successful vaginal delivery in post-term pregnancies.
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... One of them is Insulin-like Growth Factor Binding Protein 1 (IGFBP-1). IGFBP-1 will be found in cervical secretions, its presence in the cervical mucus will shows decidual activation and opening of the internal uterine ostium (Rahkonen, 2010;Benediktsdottir, Eggebø and Salvesen, 2015;Kosinska-Kaczynska et al., 2015). Previous study found that IGFBP-1 had a specificity value of 93% compared with 83% predictive value of Bishop Score in predicting premature labor (Conde-Agudelo et al., 2011). ...
... This finding was consistent with preeclampsia theory, with increment of cervical mucus IGFBP-1 level near-term. IGFBP-1 was the first sign of chorionic and decidual adhesions detachment (Kosinska-Kaczynska et al., 2015). The IGFBP-1 score in this study was lower than those found in previous study which reported a cutoff value of 10 mcg/L (Weroha and Haluska, 2012;Kosinska-Kaczynska et al., 2015). ...
... IGFBP-1 was the first sign of chorionic and decidual adhesions detachment (Kosinska-Kaczynska et al., 2015). The IGFBP-1 score in this study was lower than those found in previous study which reported a cutoff value of 10 mcg/L (Weroha and Haluska, 2012;Kosinska-Kaczynska et al., 2015). ...
Introduction: preeclampsia/eclampsia contributed to 30% of maternal mortality in RSUP Dr. Kariadi. Pre-induction bishop score assessment is a standard for cervical maturity estimation. Other predictors currently being developed, including insulin-like growth factor binding protein-1 (IGFBP-1). However, there is no cut-off point for IGFBP-1 examination in full term pregnancy, especially with preeclampsia and its complications. Objective: to find IGFBP-1 levels and Bishop Score differences in preeclampsia women with induction labor.
Methods: this prospective observational cohort study was conducted in preeclampsia women with gestational age ≥37 weeks planned labor induction at Obstetrics and Gynecology Ward RSUP Dr. Kariadi Semarang and networking hospital during study period (n=66). History taking, physical examination, proteinuria, cervical mucus IGFBP-1, and bishop score calculation was performed. Statistical analysis was performed with paired-t test, followed by ROC for cut-off value of successful induction prediction, and logistic regression to determine confounding variables effect on IGFBP-1 levels.
Results: The average Bishop score of 66 subjects was 2.5±1.81 and 2.6±1.8 for women who deliver ≤24 labor and in labor for ≤12 hours, respectively. Although the bishop score was higher in the successful labor group, there was no significant difference between groups. Mean IGFBP-1 value was 8.29±5.033 mcg/L with median value of 10.8 mcg/L. Successful induction had significant higher IGFBP-1 levels with area-under-curve (AUC) 0.76 and 8.145 cutoff value (p=0.002, RR=5.1).
Conclusion: IGFBP-1 level with cutoff point 8.145 can be used as predictor of successful labor induction in term pregnancy with preeclampsia.
... Increased mechanical stress due to uterine contractions causes disruption of chorio-decidual interface and enhanced secretion of phIGFBP-1. Numerous studies have established the role of phIGFBP-1 in preterm deliveries, but very few have established its role in the success of IOL in prolonged pregnancy and to the best of our knowledge, none have estimated the cutoff level required to predict the outcome of IOL in prolonged pregnancy [18][19][20][21][22]. ...
... ROC curve was constructed to determine the optimal cutoff level of phIGFBP-1 (7.8 µg/l) for prediction of successful IOL. As far as we know, other international studies done on the role of phIGFBP-1 in IOL used a commercially available kit (Actim Partus kit) with a detection limit of 10 µg/l [18][19][20][21][22]. In our study, phIGFBP-1 was found to have a higher sensitivity and specificity (0.87 each) for prediction of successful IOL at levels > 7.8 µg/l, when compared to studies done by Katarzyna and Vallikkannu on a similar subset of population, i.e., nulliparous females (0.67-0.48 and 0.81-0.59 ...
... The NPV was found to be the highest in our study as compared to the studies done by Katarzyna et al. and Vallikkannu et al. (0.56 and 0.58 respectively). Also, the positive LR was the highest (6.76) when compared to the studies done by Katarzyna et al. (0.56) and Vallikkannu et al. (0.58)(Table 5)[18,22]. ...
Purpose of the Study: To estimate and to compare the levels of cervical phIGFBP-1 among primigravida with prolonged pregnancy, with and without successful induction of labor (IOL).
Methods: A diagnostic study (cross-sectional study design) was conducted in our institution from November 2016 to April 2018 on 84 primigravida at≥41 weeks with uncomplicated singleton pregnancy. The results were analyzed using SPSS
software and receiver operating characteristics curves to determine the best cutoff using Youden Index. Sensitivity, specifcity, positive predictive value (PPV), negative predictive value (NPV), positive (+ LR) and negative likelihood ratio (− LR) were calculated. P value<0.05 was considered signifcant. Logistic regression analysis was used to determine the predictive ability of the three markers for successful IOL.
Results : The cutof level of phIGFBP-1, Bishop score (BS) and transvaginal cervical length (TVL) were 7.8 µg/l, 3 and 3.5 cm, respectively. The sensitivity, specifcity, PPV, NPV, + LR and − LR of phIGFBP-1 (>7.8 µg/l) were 0.87, 0.87, 0.89, 0.85, 6.76 and 0.15, respectively. Using logistic regression analysis, phIGFBP-1 was found to be the best predictor of successful IOL (OR 44.200; 95% CI 12.378–157.831, p<0.001).
Conclusion : phIGFBP-1 is a strong independent predictor successful IOL as compared to TVL and BS in primigravida with prolonged pregnancy
... 11 Several observational studies and nonsystematic reviews have reported the usefulness of cervical ultrasound and testing for the presence of pIGFBP-1 in comparison with modified Bishop score or transvaginal ultrasound of the cervical length in assessing the ripeness of the cervix for labor induction. 7,[12][13][14][15][16] The transvaginal ultrasound for the cervical length is thought to be less subjective compared with the Bishop score in assessing preinduction cervical ripening, but the major concern is that it is not clear which cutoff value of sonographically measured cervical length is most likely to indicate benefit from a method of cervical ripening prior to induction of labor. 17 A recent Cochrane systematic review in 2015 indicated that direct comparisons via randomized control trials between Bishop score and other modalities such as pIGFBP-1 and vaginal fetal fibronectin for assessing preinduction cervical ripening among parturients at term gestations was yet to be carried out. ...
... Although both methods have not been directly compared in any randomized studies, few prospective studies have compared the effects of pIGFBP-1 and Kosinska-Kaczynska et al. 16 found a positive association between cervical pIGFBP-1 and vaginal delivery following induction of labor. Their findings are in sharp similarity to ours, although our study population is exclusive of nulliparous women and more than 65% had their labor induction for post-date pregnancy. ...
... Among the three biomarkers of Premaquick, two biomarkers (native IGFBP1 and total IGFBP1) have never been evaluated for assessment of induction of labor. Previous studies have only tested phosphorylated IGFBP-1 compared with Bishop score and or TVUS [13][14][15][16] or TVUS compared with Bishop score, 4,5 and very recent Cochrane systematic review by Ezebialu et al. indicated that direct comparisons between Bishop score and pIGFBP-1 and IL-6 for assessing preinduction cervical ripening among parturients at term gestations was yet to be carried out. 17 We have only tested the kits in cervicovaginal secretions, which is another strength to our study as it makes the technique useful in facilities without need for speculum. ...
Aim:
To test whether Premaquick biomarkers were superior to modified Bishop score for preinduction cervical assessment at term.
Methods:
A multicenter, double-blind randomized clinical trial in 151 nulliparous, cephalic presenting and singleton pregnancies was conducted. The cervix was considered 'ripe' when at least two out of three Premaquick biomarkers are positive or a Bishop score of ≥6. Main outcome measures were proportion of women who were administered or had additional prostaglandin E1 analogue (PGE1) as a preinduction agent and incidence of uterine rupture. The trial was registered in PACTR registry with approval number PACTR201604001592143. Analysis was performed by intention-to-treat principle.
Results:
The need for initial PGE1 analogue (77.6% vs 98.7%, risk ratio [RR] =0.47, 95% confidence intervals [95% CI] =0.38-0.59, P < 0.001) and additional PGE1 analogue for cervical ripening after one insertion (44.7% vs 68.0%, RR = 0.63, 95% CI = 0.46-0.86, P = 0.004) was significantly lower in Premaquick group. There was no significant difference in incidence of uterine rupture (0% vs 1.4%, RR = 0.000, P = 0.324); however, the frequency of transition to labor was statistically higher in Premaquick group (44.7% vs 22.7%, RR = 1.59, 95% CI = 1.17-2.15, P = 0.004). Interval from start of induction to any type of delivery, need for oxytocin augmentation, vaginal delivery, number of women with cesarean section for failed induction and number of infants admitted to neonatal intensive care unit were similar between the two groups (P > 0.05).
Conclusion:
Preinduction cervical assessment with Premaquick was significantly associated with higher frequency of transition to labor and reduced need for PGE1 analogue when compared to modified Bishop score. Further similar trials in other settings are necessary to strengthen or refute this observation.
... 8 A phosphorylated form of IGFBP-1 is predominantly produced by human decidual cells and it is present between the chorion and decidual. 9 The chorion detaches from the decidua as pregnancy advances toward labour and releases phosphorylated form of insulin-like growth factor-binding protein-1 (phIGFBP-1) into cervico-vaginal secretions. Thus, the presence of phIGFBP-1 in cervico-vaginal secretion is an indication of decidual activation and dilatation of the internal cervical os. 9 This may signify imminent onset of labour. ...
... Thus, the presence of phIGFBP-1 in cervico-vaginal secretion is an indication of decidual activation and dilatation of the internal cervical os. 9 This may signify imminent onset of labour. The detection of phIGFBP-1 in cervico-vaginal secretions has been shown to be associated with increased risk of preterm labour, and when present at term, it is an indication that the cervix is ripe for induction of labour. ...
Objectives
To compare Premaquick biomarkers (combined insulin-like growth-factor binding protein 1 and interleukin-6) and cervical length measurement via transvaginal ultrasound for pre-induction cervical evaluation at term among pregnant women.
Methods
A randomized clinical trial of consenting pregnant women at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The women were randomized equally into Premaquick group ( n = 36) and transvaginal ultrasound group ( n = 36). The cervix was adjudged ‘ripe’ if the Premaquick test was positive or if the trans-vaginal measured cervical length was less than 28 mm. The primary outcome measures were the proportions of women who needed prostaglandin analogue for cervical ripening and the proportion that achieved vaginal delivery after induction of labour. The trial was registered in Pan African clinical trial registry (PACTR) registry with approval number PACTR202001579275333.
Results
The baseline characteristics were similar between the two groups ( p > 0.05). There was no statistically significant difference between the two groups in terms of proportion of women that required prostaglandins for pre-induction cervical ripening (41.7 versus 47.2%, p = 0.427), vaginal delivery (77.8 versus 80.6%, p = 0.783), mean induction to delivery interval (22.9 ± 2.81 h versus 24.04 ± 3.20 h, p = 0.211), caesarean delivery (22.2 versus 19.4%, p = 0.783), proportion of neonate with birth asphyxia (8.30 versus 8.30%, p = 1.00) and proportion of neonate admitted into special care baby unit (16.7 versus 13.9%, p = 0.872). Subgroup analysis of participants with ‘ripe’ cervix at initial pre-induction assessment showed that the mean induction to active phase of labour interval and mean induction to delivery interval were significantly shorter in Premaquick than transvaginal ultrasound group.
Conclusion
Pre-induction cervical assessment at term with either Premaquick biomarkers or transvaginal ultrasound for cervical length is effective, objective and safe with similar and comparable outcome. However, when compared with women with positive transvaginal ultrasound at initial assessment, women with positive Premaquick test at initial assessment showed a significantly shorter duration of onset of active phase of labour and delivery of baby following induction of labour.
... However, the cervical IGFBP-1 concentrations did not predict induction to delivery interval, as also seen in the previous study (Nuutila et al. 1999). In a recent study by Kosinska-Kaczynska et al. (2015), the presence of cervical phIGFBP-1 predicted spontaneous onset of labour and successful vaginal delivery in term and post-term pregnancies. This was not seen in our study, since the IGFBP-1 and phIGFBP-1 concentrations did not differ between women who delivered vaginally and those who delivered by caesarean section due to failure to progress. ...
... This was not seen in our study, since the IGFBP-1 and phIGFBP-1 concentrations did not differ between women who delivered vaginally and those who delivered by caesarean section due to failure to progress. In Kosinska-Kaczynska's study, women with the positive phIGFBP-1 test also developed regular uterine contractions earlier after cervical ripening (Kosinska-Kaczynska et al. 2015). A similar trend was also seen in our study, in which the IGFBP-1 and phIGFBP-1 increased more in women who started having spontaneous contractions following the FC ripening. ...
The prediction of successful labour induction is difficult, indicating a need for a biomarker test. Little is known about the effect of Foley catheter (FC) induction on biochemical mediators in the cervix, such as the insulin-like growth factor binding protein-1 (IGFBP-1), matrix metalloproteinases (MMP) and their inhibitors (TIMP). We enrolled 35 nulliparous women with singleton pregnancies, intact amniotic membranes and cephalic presentation ≥40 gestational weeks scheduled for labour induction by FC. Serial cervical swab samples were collected at FC insertion and expulsion. The concentrations of IGFBP-1, PhIGFBP-1, MMP-8, MMP-2, MMP-9, TIMP-1 and TIMP-2 were analysed. The IGFBP-1 and phIGFBP-1 concentrations increased during the FC-induced cervical ripening. In contrast, MMP-8 and MMP-9 concentrations decreased. However, these changes did not predict the outcome of the labour induction, thus appearing not suitable for clinical use.
• Impact statement
• What is already known on this subject? During cervical ripening, various constituents interact in a complex network. Insulin-like growth factor binding protein-1 (IGFBP-1), matrix metalloproteinases (MMP) and their tissue inhibitors (TIMP) appear to play a role in cervical ripening. The mechanism of Foley catheter on cervical ripening consists of direct mechanical stretching of the cervix and lower uterine segment, and the stimulation of local secretion of endogenous prostaglandins.
• What do the results of this study add? This study investigated the role of cervical biochemical mediators during Foley catheter-induced cervical ripening, and their predictive value in a successful labour induction and vaginal delivery. The IGFBP-1 and phosphorylated IGFBP-1 concentrations increased, whereas MMP-8 and MMP-9 concentrations decreased during the Foley catheter-induced cervical ripening in nulliparous women. However, these changes did not predict the outcome of labour induction, thus appearing not suitable for clinical use.
• What are the implications of these findings for clinical practice and/or further research? Prediction of a successful labour induction is difficult, indicating a need for a biomarker test. Future studies with larger data are needed for investigating the role of these cervical biomarkers in successful labour induction, and in developing a future bedside a screening tool for clinical use.
... Our results are consistent with the study conducted by Kosinska-Kaczynska et al. (7) who studied 167 women. IGFBP-1 test, TVUS-CL and Bishop score were studied in the study group where 67.5% of patients delivered vaginally and 32.5% had cesarean section. ...
... They suggested that the combined use of ultrasonographic cervical length and a novel biochemical marker like the E3-to-E2 ratio could be a good predictor of successful induction of labor. Kosinska-Kaczynska et al. [29] evaluated insulin-like growth factor binding protein-1 (IGFBP-1) in cervical secretion in term and postterm pregnancies can predict spontaneous onset of labor or successful vaginal delivery in pregnant women with induced labor. They found that the phosphorylated IGFBP-1 test may be a predictor of spontaneous onset of labor and successful vaginal delivery in postterm pregnancies. ...
We conducted a prospective study to assess serum melatonin as a biomarker to predict the development of late-term and postterm pregnancies and spontaneous beginning of labor in women with term pregnancies. Population of this prospective study included pregnant women with late-term and postterm pregnancies and term pregnancies as controls. In these study groups, serum melatonin concentrations were measured in women with or without labor and their perinatal data were collected. In the postterm pregnancies without labor, the lowest median melatonin concentrations were measured (p<0.05). In the late-term and postterm pregnancies with and without labor, the median serum melatonin concentrations were significantly lower than term ones (p<0.05). In the term pregnancies with labor, the highest median melatonin concentration was measured (p<0.05). A serum melatonin concentration≤34 pg/mL as a cut-off value determines late-term and postterm pregnancy with a sensitivity of 80.4% and a specificity of 81.4%. A serum melatonin concentration>29.35 pg/mL as a cut-off value determines presence of labor with a sensitivity of 82.1% and a specificity of 55.0%. In women with term pregnancies, with the measurement of serum melatonin, it is possible to predict the development of late-term and postterm pregnancies and whether these pregnancies undergo spontaneous labor. With further studies, these findings need to be supported before their routine clinical use.
... Transient receptor potential (TRP) channels are a family of generally nonselective cation channels that are activated and regulated by a wide variety of stimuli (4)(5)(6)(7), and play significant roles in cellular calcium homeostasis. They are involved in many physiopathologic processes, such as the formation of excitatory synapses (8,9), muscle cell proliferation (10), cancer (11,12), kidney disease (13), and platelet activation (14). TRP canonical type 3 (TRPC3) is widely expressed in the uterine smooth muscle of mammals (15). ...
Objectives:
We aimed to investigate the influence of transient receptor potential channel 3 (TRPC3) on lipopolysaccharide-induced (LPS) preterm delivery mice.
Materials and methods:
Mice were randomly assigned to the four groups: an unpregnant group, a mid-pregnancy group (E15), a term delivery group, and an LPS-induced preterm delivery group (intraperitoneal injection LPS at 15 days). Uterine smooth muscles were obtained through caesarean section; TRPC3 expression was measured by real-time PCR, western blotting, and immunohistochemistry. A specific inhibitor of TRPC3 (SKF96365) was injected into the LPS-induced preterm delivery group to determine whether the delivery interval was prolonged.
Results:
TRPC3 was primarily expressed in the uterine smooth muscle layer. In addition, the LPS-induced preterm delivery group had an obviously higher expression level of TRPC3 mRNA and protein compared with the unpregnant and E15 groups, which were close to term delivery. More importantly, SKF96365 prolongs the delivery interval of LPS-induced preterm delivery mice.
Conclusion:
Enhanced expression of TRPC3 may be associated with LPS-induced preterm delivery in mice. The specific inhibitor of TRPC3 (SKF96365) may be helpful for clinical treatment of preterm delivery.
Preterm labor (PTL) is a severe issue of neonatal healthcare because its related to preterm birth (PTB) is the leading cause of neonatal mortality and the most common reason for antenatal hospitalizations. The PTB rate is about 11% globally and it is similar in the United States. PTB poses a significant economic burden on the healthcare system. Early diagnosis of PTL is the key to reducing PTB rate, neonatal mortality, and long-term neurological impairment in children. The diagnosis of PTL is usually based on clinical criteria, but the accuracy of the diagnosis is poor. To predict the risk of PTL more accurately, tests of biomarkers with variable clinical diagnostic performances have been developed and some of them have been applied clinically. In this article, we analyze the performance characteristics of these biomarkers, such as sensitivity, specificity, positive predictive value, and negative predictive value, as well as the clinical utility of current biomarkers so that clinical laboratorians and clinicians can better understand the limitations of these tests and utilize them wisely. We also summarize the current recommendations on clinical utilization of PTL biomarkers. Finally, we explore the prospects of future omics-based novel biomarkers, which may improve prediction of PTL in the future.
Objective
To compare early induction and expectant management regarding delivery outcomes and the experience of delivery in nulliparous women with prolonged latent phases. Design: Randomized controlled trail.SettingOne delivery unit in a Swedish hospital.PopulationNulliparous women at term experiencing continuous contractions impeding rest (women's report) and exceeding 18 hours, a cervical dilation of less than four centimeters, intact membranes and with a singleton fetus in cephalic presentation.Methods
The women were randomly allocated to either early induction (n = 65) or expectant management (n = 64). All participants received medication for therapeutic rest. The early induction group was induced five hours after medication, and the expectant group awaited spontaneous onset of labor. The Wijma Delivery Experience Questionnaire (W-DEQ version B) was filled in after delivery.Main Outcome MeasuresThe primary outcome was mode of delivery. Secondary outcomes included birth experience, duration of labor, postpartum hemorrhage, and neonatal outcomes.ResultsThe cesarean section rate was 15 of 65 (23.1%) in the early induction group compared to 24 of 64 (37.5%) in the expectant group (p = 0.076, OR 2.00, 95% CI 0.93-4.31). No significant differences were shown regarding delivery or neonatal outcomes or birth experience.Conclusions
No significant differences were shown between the two groups in the rate of cesarean sections or the experience of delivery. According to the actual results the power to detect a difference was only 45 %. The cesarean section rate was high in both groups, regardless of intervention.This article is protected by copyright. All rights reserved.
The aim of this work is to evaluate levels of placental growth hormone (PGH), pituitary growth hormone (GH1), insulin-like growth factor (IGF-I) and ghrelin in pregnant women's blood serum before, during and after delivery. Furthermore, the aim is to search for links and interdependence of GH1, PGH and IGF-I concentrations.
Seventy nine blood samples were taken one to two hours before, during and half an hour after expulsion of placenta. All proteins studied were determined by ELISA method, using ELISA Kit.
The highest PGH concentration and IGF-I concentration in pregnant women's blood serum was observed before delivery while GH1 concentration was lowest. During and after delivery PGH and IGF-I concentration decreased proportionately and pituitary growth hormone concentration increased accordingly. About half an hour after delivery of the placenta, GH1 concentration was highest.
In pregnant women's blood there is a metabolic interdependence between PGH and IGF-I. Their concentration increases proportionately during pregnancy and decreases after delivery. It appears that labor and delivery releases GH1 blockade, which level rises three-fold during delivery. After parturition its role and concentration returns to levels before pregnancy.
The aim of this multicentric study is to compare clinical, biophysical and molecular parameters in the prediction of the success of labour induction with prostaglandins.
We included 115 women, who underwent to labour induction at term with vaginal prostaglandin gel. We evaluated the diagnostic efficiency of endocervical phosphorylated insulin-like growth factor-binding protein (phIGFBP-1), cervicovaginal interleukins 6 (IL-6) and 8 (IL-8). We analyzed the transvaginal sonographic measurement of cervical length. A receiver-operating characteristics (ROC) curve was used to determine the most useful cut-off point. A multivariate logistic regression model was used to analyze the combination of significant predictive variables following univariate analysis. We analyzed all the data searching for the parameters that best predict the beginning of the active phase of labour within 12 h.
36.5 % of the patients delivered within 12 h. The Bishop score was >4 in the 43 % of patients with an active phase. The best cut-off values at ROC curves for cervical length, IL-6 and IL-8 were respectively 22 mm, 5 mg/dl and 20,237 mg/dl. At univariate analysis, all predictors of success, with the exception of IL-6, were significantly associated with the beginning of the active phase. Multivariate analysis of the Bishop score (OR 2.3), phIGFBP-1 test (OR 11.2) and IL-8 (OR 6.6) showed that the variables were independent and therefore useful in combination to predict the success of labour induction.
The phIGFBP-1 test is a fast and easy test that can be used with Bishop score and IL-8 to reach an high positive predictive value in the prediction of the success of labour induction with prostaglandins.
Background. The aim of the study was to evaluate whether the phosphorylated isoforms of insulin‐like growth factor‐binding protein‐1 (IGFBP‐1), a protein produced by the decidua, can be detected in cervical secretions of pregnant women with preterm uterine contractions, and whether their presence predicts an increased risk of preterm delivery.
Methods. A prospective analysis of sixty‐three women who presented with preterm labor but intact fetal membranes at weeks 22–36+6 days of gestation at the Antenatal clinic at the Department of Obstetrics and Gynecology, Helsinki University Central Hospital. Phosphorylated IGFBP‐1 (phIGFBP‐1) was measured in cervical swab samples obtained at presentation, using an immunoenzymometric assay. The values ≥10μg/L were considered as positive. In addition, 58 asymptomatic women at the same gestational stage were studied as controls. Multiple logistic regression was applied to control for confounding variables and to obtain adjusted odds ratios.
Results. The concentration of phIGFBP‐1 in cervical samples ranged from undetectable to 95 μg/L. In 17 of the 63 (27%) women with preterm labor it was ≥10 μg/L. Seven of these 17 (41%) women with a positive phIGFBP‐1 result delivered preterm, all before 35 weeks of gestation. Among the women with preterm labor and a negative phIGFBP‐1 result, three of the 46 (7%) delivered before 37 weeks of gestation (adjusted OR 24, 95% CI 1.2–487), but all after 35 weeks of gestation. In the asymptomatic control population three out of 58 (5%) women had a positive cervical phIGFBP‐1 test result but none delivered preterm. Among the controls with a negative cervical phIGFBP‐1 test result (55 of 58, 95%), one woman delivered preterm (1 of 55, 2%).
Conclusions. Pregnant women who are in preterm labor with intact fetal membranes and who have a positive phIGFBP‐1 test result in cervical secretion have an increased risk of preterm delivery.
Background:
As a pregnancy continues beyond term the risks of babies dying inside the womb or in the immediate newborn period increase. Whether a policy of labour induction at a predetermined gestational age can reduce this increased risk is the subject of this review.
Objectives:
To evaluate the benefits and harms of a policy of labour induction at term or post-term compared with awaiting spontaneous labour or later induction of labour.
Search methods:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2012).
Selection criteria:
Randomised controlled trials conducted in women at or beyond term. The eligible trials were those comparing a policy of labour induction with a policy of awaiting spontaneous onset of labour. Cluster-randomised trials and cross-over trials are not included. Quasi-random allocation schemes such as alternation, case record numbers or open random-number lists were not eligible.
Data collection and analysis:
Two review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. Outcomes are analysed in two main categories: gestational age and cervix status.
Main results:
We included 22 trials reporting on 9383 women. The trials were generally at moderate risk of bias.Compared with a policy of expectant management, a policy of labour induction was associated with fewer (all-cause) perinatal deaths: risk ratio (RR) 0.31, 95% confidence interval (CI) 0.12 to 0.88; 17 trials, 7407 women. There was one perinatal death in the labour induction policy group compared with 13 perinatal deaths in the expectant management group. The number needed to treat to benefit (NNTB) with induction of labour in order to prevent one perinatal death was 410 (95% CI 322 to 1492).For the primary outcome of perinatal death and most other outcomes, no differences between timing of induction subgroups were seen; the majority of trials adopted a policy of induction at 41 completed weeks (287 days) or more.Fewer babies in the labour induction group had meconium aspiration syndrome (RR 0.50, 95% CI 0.34 to 0.73; eight trials, 2371 infants) compared with a policy of expectant management. There was no statistically significant difference between the rates of neonatal intensive care unit (NICU) admission for induction compared with expectant management (RR 0.90, 95% CI 0.78 to 1.04; 10 trials, 6161 infants). For women in the policy of induction arms of trials, there were significantly fewer caesarean sections compared with expectant management in 21 trials of 8749 women (RR 0.89, 95% CI 0.81 to 0.97).
Authors' conclusions:
A policy of labour induction compared with expectant management is associated with fewer perinatal deaths and fewer caesarean sections. Some infant morbidities such as meconium aspiration syndrome were also reduced with a policy of post-term labour induction although no significant differences in the rate of NICU admission were seen.However, the absolute risk of perinatal death is small. Women should be appropriately counselled in order to make an informed choice between scheduled induction for a post-term pregnancy or monitoring without induction (or delayed induction).
The aim of this study was to compare the efficacy of oxytocin and dinoprostone in achieving successful labor induction and vaginal delivery in postterm women with an unfavorable cervix.
Postterm women with an uncomplicated pregnancy and a Bishop score of ≤6 were randomized to receive either dinoprostone vaginal pessary (Propess®) or low-dose oxytocin. The primary outcomes were the length of the induction-to-delivery period and the incidence of vaginal delivery.
A total of 144 women were available for the analysis. The overall vaginal delivery rates were 75% (54/72) for the dinoprostone group and 80.6% (58/72; p = 0.35) for the oxytocin group; the mean induction-to-vaginal delivery interval was 13.3 and 10.3 h in the dinoprostone and the oxytocin group, respectively (p = 0.003). Uterine hyperstimulation was 7.4% compared with 6.8% (p = 0.8), and abnormal fetal heart rate was 26.4% compared with 18% (p = 0.2), respectively.
Both oxytocin and dinoprostone seem to have similar obstetric outcomes in postterm pregnancies with an unfavorable cervix, except for a significant superiority of oxytocin for delivery in a shorter period.