Improving Predictions of Preterm Delivery

Doctor’s hand moving ultrasound on a pregnant woman’s belly.

Preterm birth is a leading cause of infant death and long-term disability related to the nervous system in the United States. Identifying pregnant people at risk for preterm delivery is essential for developing safe, effective strategies to reduce the negative consequences of preterm birth.

Many factors contribute to the risk of delivering preterm, including short cervical length measured by sonography. Scientists in the Perinatology Research Branch external link set out to identify determinants of imminent delivery among pregnant women diagnosed with a sonographic short cervix.

The researchers, led by Drs. Roberto Romero and Adi Tarca, found that the abundance of certain proteins in the amniotic fluid can predict imminent delivery among women with a sonographic short cervix. They analyzed 1,310 proteins in amniotic fluid samples from 90 women diagnosed with a sonographic short cervix during the second or third trimester of pregnancy. The women underwent amniocentesis—a procedure in which amniotic fluid is removed from the uterus for testing—to rule out the possibility of intra-amniotic infection. None of the women showed clinical signs of infection.

Of the proteins tested, 17 were differently abundant in women who delivered within two weeks after amniocentesis. While cervical length alone could predict imminent delivery in 38% of cases, combining cervical length with the abundance of four of these proteins increased the sensitivity to 79% (false positive rate of 10%). This improved prediction of the timing of delivery compared to cervical length measurement alone could be helpful to optimize care of patients—for example, to help determine place of care or administration of antenatal steroids.

Learn more about the Maternal-Fetal Medicine and Translational Imaging Affinity Group: https://www.nichd.nih.gov/about/org/dir/affinity-groups/MFMTI

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