An Evaluation of Formal Risk Scoring for Preterm Birth

Abstract

Formal risk scoring systems for the prediction of preterm birth lack many of the characteristics that are required from effective screening tests. They show poor positive predictive values, poor reproducibility, and large differences in performance among different populations. In clinical practice the implementation of these scoring systems has not shown to confer more benefit than harm to the women and infants involved. There is no conclusive evidence for reduction of the incidence of preterm birth, especially among women considered to be at high risk on the basis of such scores. The use of these scores has led to a profusion of interventions being applied to women without demonstrable benefit for them from these interventions. The introduction of formal risk scoring for preterm birth thus profoundly alters the type of care available to pregnant women. The main effect thus far appears to be that a potential but relatively imprecise risk of preterm birth tends to be replaced by the certain risk of dubious treatments, whose merits are undocumented and whose hazards are unknown. There is great need for controlled studies to establish whether and for whom potential benefits of formal risk scoring can outweigh its hazards.

Transvaginal sonographic examination of the cervix in asymptomatic pregnant women: review of the literature

“…The rate of spontaneous very preterm births has not decreased significantly in the past 30 years and preterm deliveries account for 5.9% and 10.7% of all deliveries in France and the USA, respectively 2,3 . Two main factors contribute to such disappointing figures: (1) the inadequacy of our therapeutic arsenal; indeed, only tocolytics attempt to treat symptoms of preterm labor; (2) the absence of reliable criteria for the selection of a high-risk population for preterm delivery [4][5][6][7][8][9][10][11] .…”

Role of uterine artery velocimetry using color‐flow Doppler and electromyography of uterus in prediction of preterm labor

“…The Papiernik score was higher in the preterm group compared with term deliveries (5.38 ± 4.23 vs 4.88 ± 3.99); however, this difference was not significant. Keirse reviewed the various formal risk scores and found they had a low positive predictive value and poor reproducibility, with large differences in performance between different populations 11 . The cervical length was shorter in the preterm group at all gestations, although this difference was not significant.…”

Déclencher sans délai ou attendre devant une rupture des membranes à terme sur col défavorable ? N’ayons pas peur de l’expectative !

“…Dans les groupes avec déclenchement différé, on observait que la majorité des patientes entraient spontanément en travail dans les heures qui suivaient la rupture, avant d'atteindre la limite de délai prévue dans le bras expectative. Les taux variaient de 60 % d'entrée en travail spontané dans les 24 heures, à 95 % dans les 36 heures, même en cas de col défavorable lors de la perte des eaux [2]. Une des études les plus importantes sur ce thème était le rapport du groupe international Term PROM.…”