Association Between Features of Spontaneous Late Preterm Labor and Late Preterm Birth

Angelica V. Glover; Ashley N. Battarbee; Cynthia Gyamfi-Bannerman; Kim A. Boggess; Grecio Sandoval; Sean C. Blackwell; Alan T. N. Tita; Uma M. Reddy; Lucky Jain; George R. Saade; Dwight J. Rouse; Jay D. Iams; Erin A. S. Clark; Edward K. Chien; Alan M. Peaceman; Ronald S. Gibbs; Geeta K. Swamy; Mary E. Norton; Brian M. Casey; Steve N. Caritis; Jorge E. Tolosa; Yoram Sorokin; Tracy A. Manuck; for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network

doi:10.1055/s-0039-1696641

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2020; 37(04): 357-364
DOI: 10.1055/s-0039-1696641

SMFM Fellowship Series Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Association Between Features of Spontaneous Late Preterm Labor and Late Preterm Birth

Angelica V. Glover

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

Ashley N. Battarbee

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

Cynthia Gyamfi-Bannerman

²Department of Obstetrics and Gynecology, Columbia University, New York, New York

,

Kim A. Boggess

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

Grecio Sandoval

³George Washington University Biostatistics Center, Washington, District of Columbia

,

Sean C. Blackwell

⁴Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas

,

Alan T. N. Tita

⁵Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama

,

Uma M. Reddy

⁶Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

,

Lucky Jain

⁷Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia

,

George R. Saade

⁸Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

Dwight J. Rouse

⁹Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island

,

Jay D. Iams

¹⁰Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio

,

Erin A. S. Clark

¹¹Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah

,

Edward K. Chien

¹²MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio

,

Alan M. Peaceman

¹³Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

,

Ronald S. Gibbs

¹⁴Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado

,

Geeta K. Swamy

¹⁵Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina

,

Mary E. Norton

¹⁶Department of Obstetrics and Gynecology, Stanford University, Stanford, California

,

Brian M. Casey

¹⁷Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, Texas

,

Steve N. Caritis

¹⁸Department of Obstetrics and Gynecology, University of Pittsburg, Pittsburg, Pennsylvania

,

Jorge E. Tolosa

¹⁹Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon

,

Yoram Sorokin

²⁰Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan

,

Tracy A. Manuck

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network

› Institutsangaben

Abstract

Objective This study aimed to evaluate the association between clinical and examination features at admission and late preterm birth.

Study Design The present study is a secondary analysis of a randomized trial of singleton pregnancies at 34^0/7 to 36^5/7 weeks' gestation. We included women in spontaneous preterm labor with intact membranes and compared them by gestational age at delivery (preterm vs. term). We calculated a statistical cut-point optimizing the sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth and used multivariable regression to identify factors associated with late preterm delivery.

Results A total of 431 out of 732 (59%) women delivered preterm. Cervical dilation ≥ 4 cm was 60% sensitive and 68% specific for late preterm birth. Cervical effacement ≥ 75% was 59% sensitive and 65% specific for late preterm birth. Earlier gestational age at randomization, nulliparity, and fetal malpresentation were associated with late preterm birth. The final regression model including clinical and examination features significantly improved late preterm birth prediction (81% sensitivity, 48% specificity, area under the curve = 0.72, 95% confidence interval [CI]: 0.68–0.75, and p-value < 0.01).

Conclusion Four in 10 women in late-preterm labor subsequently delivered at term. Combination of examination and clinical features (including parity and gestational age) improved late-preterm birth prediction.

Keywords

ALPS - late preterm birth - spontaneous labor - prediction - preterm labor

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Referenzen

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