Prediction of Prematurity: Multi-dimensional Analysis
of a Prospective Clinical Study
Mára M., Dohnalová A., Žižka Z., Haaková L., Hájek Z., Calda P., Živný J.
Gynekologicko-porodnická klinika UK 1. LF a VFN, přednosta prof. MUDr. J. Živný, DrSc. Fyziologický ústav, UK 1. LF , Oddělení kybernetiky, přednosta prof. MUDr. S. Trojan, DrSc. |
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Summary:
Objective: To evaluate, which of selected anamnestic, laboratory and ultrasonographic (USG)
parameters could contribute to the prediction of prematurity.
Design: Prospective, observational, clinical study.
Setting: Department of Obstetrics and Gynecology, 1
st
Faculty of Medicine and the General Facul-
ty Hospital, Charles University, Prague. Methods: 349 women with the singleton pregnancy were followed from the half of the 2
nd
trimes-
ter untill the end of gestation. At each woman the anamnestic (age, parity, pregravid BMI, weight
gain untill 20
th
week, significant risk from patient’s history, cigarette smoking, risk pregnancy
symptoms untill 20
th
week), laboratory (maternal serum concentration of AFP, hCG, and uE3
/triple test/ at 16
th
week, the blood count and ferritin concentration at 18
th
–20
th
week, bacteriolo-
gical cultivation of the smear from the cervix at 34
th
–36
th
week), and USG (transvaginal cervico-
metry and doppler flowmetry of the uterine arteries at 18
th
–20
th
week) data were established.
With the aid of one-dimensional and multi-dimensional analysis the dependence of completed
gestational age and preterm delivery (before completed 37
th
week) on above mentioned parame-
ters was tested.
Results: 314 women completed the study. We proved a significant dependence of prematurity on
the following markers: risk pregnancy symptoms until 20
th
week (RR 2.94), abnormal triple test
(RR 4.63), cultivation of pathogens from the cervix (RR 5.49), USG established cervical length
(P<0.0001), abnormal result of cervicometry (RR 19.02), both doppler parameters (RI of uterine
arteries: P<0.0001; presence of early diastolic notch: RR 2.84). The results of multi-dimensional
analysis confirmed superiority of USG cervicometry in prediction of both measured outcomes.
Conclusion: The predictive value of some of selected anamnestic, laboratory, and USG markers of
premature delivery was proved at random population of women with singleton pregnancy. The
abnormal result of transvaginal USG cervicometry was the most significant predictor of prematu-
rity. We recommend a routine performing of cervicometry (as a part of USG screening at 18
th
–20
th
week) for early selection of women with significantly increased risk of prematurity.
Key words:
cervicometry, multi-dimensional analysis, prediction, prematurity, screening
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