Volume 176, N u m b e r 1, Part 2 A m J Obstet Gynecol

SPO Abstracts 147

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CERVICAL ULTRASOUND LENGTH AND OUTCOME IN PREGNANCIES COMPLICATED BY IN UTERO EXPOSURE T O DIETHYLSTILBESTROL (DES) S. E1Azeem, JR Samuels and ~D. Iams. The Ohio State University" Hospitals, Columbus, Ohio OBJECTIVE: To determine in patients with history of in utero DES exposm-e if there is a significant difference in cervical length between dmse who deliver at term and those who deliver pretenn. STUDY DESIGN: We performed cervical transvaginal sonography between 21 and 26 weeks gestation on 28 patients with a history of DES exposure in utero and 106 normal pregnancies delivering at term. DES patients were followed throughout gestation and were subsequently subdivided into those who delivered prior to 37 weeks (preterm) and those who delivered at or beyond 37 weeks (term). Ditfierences in cervical length were analyzed using an unpaired t-test. We first compared normal pregnancies with all DES patients, and then compared the DES patients delivering preterm with those delivering at term. RESULTS: The mean cervical length (in ram) of all DES patients measured at 21-26 weeks (n = 28) was 30.5 + 7.5 vs 36 + 6 for the normal patients (n = 106) (p = 0.0001). One patient with DES was excluded because of indicated preterm delivery. The nman cmMcal lengdl of the 10 patients who delivered preterm was 31.5 -+ 8 compared to 31.1 _+ 5 in the 17 patients who delivered at term (p = 0.9). CONCLUSION: 58% of the patients with in utero exposure to DES delivered less than 37 week. Cervical ultrasound was not useful in predicting preterm delivery in these patients, suggesting that factors other than cervical shortening may be responsible for early deliver}, in these patients.

THE PRETERM PREDICTION STUDY: SCREENING LOW RISK WOMEN FOR SPONTANEOUS PRETERM BIRTH WITH DIGITAL EXAMINATION, FIBRONECTIN, AND SONOGRAPHIC CERVICAL LENGTH. IamsJD tbr the NICHD Maternal Fetal Medicine Unit Network, Beflmsda, MD. OBJECTIVE: To predict spontaneous preterm birth (SPTB) in low risk pregnancy. STUDY DESIGN: Bishop Score (BS); fetal fibronectin (FFN); and sonographic cerr length (CL) were obtained at 22-24 weeks in all women enrolled in the Preterm Prediction Study. BS (positive - >4); FFN (positive - >50 n g / d l ) , and CL (short = -<25 ram) were evaluated as screening tests for risk of SPTB "<35 weeks in women who had no history of preterm birth nor of 1st or 2nd trimester loss. RESULTS: There were 1208 nulliparous and 900 parous women who met selection criteria; 64 (3.04%) had SPTB "<35 weeks. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and relative risk (RR) and 95% confidence intervals (CI) for the ability of each test to identify SPTB <35 weeks are shown.

Prediction of SPTB <35 Weeks in Low Risk Women BS +

n (%) + for test # SPTD Sensitivity % Specifici9' % PPV % NPV % RR SPTB 95% CI 165 (7.8%) 15 23.4 92.6 9.1 97.5 3.6 2.1-6.3

CL +
179 (8.5%) 25 39,1 92.5 14.0 98.0 6.9 4.5-10.6

FFN +
76 (3.6%) 15 23.4 97.0 19.7 97.6 8.2 4.8-13.9

CONCLUSION: All tests had low sensitivity. A positive FFN had greater RR and superior PPV in this low risk population.

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THE PRETERM PREDICTION STUDY: A MODEL FOR ESTIMATION OF RISK OF SPONTANEOUS PRETERM BIRTH IN PAROUS WOMEN. Iams[D for the NICHD Maternal Fetal Medicine Unit Network, Bethesda, MD. OBJECTIVE: To estimate risk of spontaneous preterm birth (SPTB) by obstetrical history (OB Hx), t~tal fibronectin (FFN) and sonographic cervical length (CL). STUDY DESIGN: The probability of SPTB "<35 weeks was estimated from a logistic regression model using data frmn 1277 parous women enrolled in the Preterm Prediction Study and analyzed according to OB Hx (prior SPTB at 18-26 wks, 27-31 wks, 32-36 wks, and Term ->37 weeks), FPN status (positive = ~50 n g / d l ) , and CL by percentile groups {-<10th (--<25 ram), 10th-50th (26-35 mm), and >50th (>35 ram)} measured at 22-24 wks. FFN and CL were blinded for care. RESULTS:

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Estimated Probability of SPTB <35 wks OB Hx:

nmnber OB Hx alone FFN Positive CL <25 mm CL 26-35 mm CL >35 mm FFN Negative CL ~<25 mm CL 26-35 mm CL >35 mm

18 26 wks
95 .17 .66 .48 .30 .28 .15 .08

27-31 wks
76 .20 .71 .54 .35 .33 .18 .10

32 36 wks
202 .12 .59 .40 .24 .22 .12 .06

Term
904 .03 .25 .14 .07 .06 .03 .01

CONCLUSION: The estimated risk of SPTB in parous women varies widely according to CL, FFN, and OB Hx. Predicted recurrence risk rises as CL shortens in both FFN positive and FFN negative women. Prediction of individualized recurrence risk for SPTB may be useful in the care of subsequent pregnancies in women with a prior SPTB.

ELEVATED MATERNAL SERUM INTERLEUKIN-6 CONCENTRATIONS AS A MARKER FOR IMPENDING PRETERM D ~ Y . AP Murtha ~'1, P Greigl, CEflmmerson xl, B. Roi~man-Johnson"2, J Allen~2, WNP Herberfl. Dept. OB/GYN, Duke University, Durham, NC 1 and R&D Systems, Minn, MN z. OBJECTIVE: To determine if serum interleukin45 (IL-6) concentrations predict impending preterm delivery. STUDY DESIGN: Blood samples were obtained from 130 patients at 22-34 weeks gestation. The control group (n = 41) consisted of outpatients seen for routine obstetric visits. The study group (n - 89) consisted of patients evaluated on labor and delivery for preterm contractions or preterin premature rupture of membranes (PROM). Only" one sermn sample fi-om each patient was included in the analysis. Senm~ 1L-6 concentrations were determined using a specific ELISA kit (R&D Systems). Analysis was by Mann ~qlitney U and I~-uskal Wallis test. RESULTS: Of the 41 control patients, all had serum IL-6 concentrations < 8 pg/ml. Of the 89 study patients, 16 had serum IL-6 concentrations ~>8 p g / m l and 73 were <8 pg/ml. When the serum IL-6 concentration was >8, the interval fi-om blood collection to delivery, was significantly shorter than that of study or control patients with serum IL-6 < 8 (median 5.5 vs 240 vs 1801 hours, p < .0001). Gestational age at delivery was significantly lower when the serum |L-6 concentration was -->8, compared to study or controls with serum IL-6 <8 (29.6 vs 33.4 vs 39 weeks, p < .0001). Samples from patients with preterm contractions were also analyzed separately from those diagnosed with PROM. In patients with preterm contractions, the interval fi-om blood collection to delivery was significantly shorter when the serum IL-6 concentration was ~ 8 vs < 8 p g / m l (3 vs 600 hours, p < .0001). Similarly, gestational age at delivery was also significantly lower when the serum 1L-6 concentration was ~>8 vs < 8 pg/rnl (29.0 vs 36.1 weeks, p = .001). CONCLUSION: Maternal serum 1L-6 concentrations ->8 p g / m l are significantly associated with delivery at an earlier gestationaI age and a shortened interval from blood collection to delivery than patients with IL-6 <8 pg/ml. Measurement of sermn IL-6 concentration may serve as a useful marker for prediction of impending preterm delivery.