Beta-human chorionic gonadotropin concentrations in cervicovaginal secretions as an early marker of preterm delivery

Abstract

ÖZETAmaç: Preterm doğum erken belirteci olarak serviko-vajinal sekresyonlardaki koriyonik gonadotropin'in rolünü araştırmak.Yöntemler: Bir önceki doğumu erken doğum veya ikinci trimester düşük öyküsü risk faktörü olan, 25-36 gebelik haftasına sahip 55 gebe çalışmaya alındı. Hastaların tü-münde servikovajinal sekresyonlardaki beta-insan koriyonik gonadotropin (β-hCG) düzeyleri radioimmunassay yöntemiyle ticari bir kit kullanılarak ölçüldü. Bulgular:Gebelerden 25'i preterm, 30'u term doğum yaptı. Term ve preterm doğum yapana gebe grupları arasında yaş, gebelik sayısı ve parite açısından farklılık saptanmadı (P>0.05). Preterm doğum grubunda yenidoğan APGAR skorları ve bebeklerin antropometrik ölçümleri term doğum grubundan anlamlı düşük bulundu (P<0.05). Serviko-vaginal β-hCG düzeyleri; preterm grubunda, term doğum grubuna göre anlamlı yüksek bulundu (sırasıyla 94.7±37.7 mIU/ml ve 35.5±14.8 mIU/ml, P<0.001). Beta-hCG için, 75 mIU/ml cut-off değeri olarak alındığında; duyarlılığı %76, özgüllüğü %91.6, pozitif prediktif değeri %95 ve negatif prediktif değeri %79.9 olarak bulundu. Sonuç: Preterm doğum açısından yüksek riskli hastalarda servikovajinal sekresyonlardaki β-hCG konsantrasyonu iyi bir biyokimyasal belirteç olabilir. Servikovajinal sıvılardaki β-hCG düzeyine dayanarak preterm doğum geliştireceği öngörülen hastalarda daha yakın takip ile komplikasyonlar azaltılabilir. Klin Den Ar Derg 2010; 1(1): [16][17][18][19][20] Anahtar kelimeler: Preterm doğum, beta-hCG, prediktif değer, serviko-vajinal sekresyonlar ABSTRACT Objectives: To investigate beta-human corionic gonadotropin (β-hCG) levels in cervicovaginal secretions as an early marker for preterm delivery. Methods:The study included 55 patients at 25-36 of gestational weeks with preterm delivery risk factors including a history of preterm labor in a previous pregnancy or history of second trimester abortion. Beta-human chorionic gonadotropin (β-hCG) levels of cervicovaginal secretions were measured in all patients by the radioimmunoassay method using a commercial kit.Results: Preterm delivery was observed in 25 patients and 30 patients gave term delivery. No significant differences were found between preterm and term delivery groups in age, gravidity and parity (P>0.05). APGAR scores and anthropometric measurements of newborns were significantly lower in preterm delivery group (P<0.001). Preterm delivery group had significantly higher cervicovaginal β-hCG levels compared with normal controls (94.7±37.7 vs. 35.5±14.8 mIU/ml, respectively, P<0.001). When 75 mIU/ml value of β-hCG level was taken as cut-off value; the sensitivity of the test was found as 76%, specifity 91.6%, positive predictive value 95.0% and negative predictive value as 79.9%. Conclusion:Concentrations of β-hCG in cervicovaginal secretions may be a useful early biochemical marker to detect preterm. Based on β-hCG levels in cervicovaginal secretions a closer follow-up may decrease some complications of preterm delivery.

Role of cervicovaginal β-hCG in prediction of preterm delivery: a prospective observational study

“…33 Adhikari et al also concluded that cervicovaginal β-hCG may have a role in predicting preterm delivery both in symptomatic and asymptomatic women at high-risk for preterm delivery, but cut off value of β-hCG in their study was very low 14 mIU/ml for predicting delivery <34 week with sensitivity, specificity, positive and negative predictive value of 83.3%, 85.5%, 33.3% and 98.3% respectively, 4.75 mIU/ml for predicting delivery <37 week with sensitivity, specificity, positive and negative predictive value of 70%, 61.8%, 40% and 85% respectively as compared to present study. 34 Present study had comparable sensitivity and negative predictive value to Erdalsak et al, Mishra et al 9,35 They found a cut off value of 13.5 mIU/ml for cervicovaginal β-hCG for prediction of preterm delivery with sensitivity 71.1%, specificity 81.2%.…”

“…This sample was sent to laboratory immediately after collection. 9 The assay procedure began with centrifugation of the solution at 3500×g for 5 min to remove particulate matter. The remaining solution was quantitatively tested for the presence of β-hCG.…”

“…Additionally, aggressive tocolysis therapy can be avoided. 9 Identification and timely referral for specialized obstetrical evaluation and management of these high-risk women pre-conceptually or in early pregnancy, is important in reducing the morbidity, mortality, psychological trauma and expense associated with preterm birth. 3 Research on many biomarkers in the maternal serum, amniotic fluid, and CVF are accomplished but not a single biomarker has evolved till date, which possesses sensitivity as well as reliability for the detection of spontaneous preterm birth.…”

“…Their original study suggested that quantitative measurement of hCG from vaginal fluid may serve as a useful marker of premature rupture of fetal membranes secretions. 9 Cervicovaginal presence of β-hCG in maternal serum and amniotic fluid are the result of diffusion throughout pregnancy. Source of elevated β-hCG in cervicovaginal secretions are maternal serum or amniotic fluid.…”

Comparison of serum ferritin levels in pregnant women with preterm and term deliveries

“…such as cervical length measurement through transvaginal ultrasound, bacterial vaginosis tests, fetal fibronectin, hCG in cervical and vaginal secretions (5,6), maternal corticotropin releasing hormone (CRH) (7), and maternal serum alpha fetoprotein in 11-13 weeks (8), have been suggested to predict preterm delivery; however none of them are able to accurately identify cases at risk for preterm delivery and its related complications (9,10). Acute phase response is defined as the systemic response to inflammation and tissue damage that occurs within hours to days (11).…”