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Test May Predict Moms Who Will Deliver Prematurely
Date:7/21/2009

Analysis of amniotic and cervical fluids yields clues to early birth

TUESDAY, July 21 (HealthDay News) -- Testing for a panel of proteins in amniotic and cervical fluids might enable doctors to identify women who are in danger of giving birth prematurely.

No such test exists now. If perfected, such a tool could supplement a test now available that can determine which women face a lower risk of delivering early.

"It is a breakthrough since it will provide a high positive predictive value," said Dr. Bo Jacobsson, who is with the perinatal center at Sahlgrenska University Hospital in Gothenburg, Sweden, and senior author of a study on the test. But its effectiveness will need confirming in a prospective study, he added.

The study is reported in the August issue of Obstetrics & Gynecology.

"It's very exciting. There's no question this could be very helpful, but the problem is these are really preliminary findings," said Dr. Marjorie Greenfield, associate professor of obstetrics and gynecology at Case School of Medicine and University Hospitals in Cleveland. "The test doesn't exist. It's in a research lab only. It's not clinically available."

Babies born prematurely often suffer significant medical problems, including breathing difficulties as a result of incompletely developed lungs. In the United States and other countries, the incidence of preterm delivery is increasing and now stands at about 12.5 percent, although the upward trend may be skewed by a higher number of multiple births, said Dr. Michael Cabbad, chairman of obstetrics and gynecology and chief of maternal/fetal medicine at the Brooklyn Hospital Center in New York City.

Doctors now use imperfect clinical measures, such as cervix length, to predict when a birth will occur.

For the study, the researchers took samples of amniotic and cervical fluids from 89 women in preterm labor. They then analyzed 37 proteins from the samples and came up with two groups of proteins that predicted delivery within the next seven days better than any single protein.

One of the models, which included proteins found in amniotic and cervical fluids, predicted birthing with 91 percent accuracy. The other test, which included measuring the cervix, was 85 percent accurate.

But even with effective predictive tests, another significant problem remains: what to do with the women at higher risk.

"Even if we can predict who's going to deliver soon, we don't really have any tricks up our sleeve that will prevent that," Greenfield. "There are medications that we use, but none are very effective."

Still, identifying women at higher risk would enable doctors to give babies steroids in the womb to help mature their lungs faster, Greenfield said. These are considered most effective when given two to seven days before delivery.

"We could time our steroids," she said.

Cabbad added that "any work in the area of preterm birth and the ability to help us diagnose those patients who may be at risk for preterm birth is beneficial as we go forward."

"We're still looking for the magic wand that's going to be able to pass over each patient to determine who's at higher risk," he said.

More information

The March of Dimes has more on premature birth.



SOURCES: Bo Jacobsson, M.D., Ph.D., perinatal center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden; Marjorie Greenfield, M.D., associate professor, obstetrics and gynecology, Case School of Medicine and University Hospitals, Cleveland; Michael Cabbad, M.D., chairman, obstetrics and gynecology, and chief, maternal/fetal medicine, Brooklyn Hospital Center, New York City; August 2009, Obstetrics & Gynecology


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