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#Grand Rounds

Clinical and Examination Factors: A New Model for Predicting Spontaneous Late Preterm Birth

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BACKGROUND AND PURPOSE:

  • Improved prediction models could help identify which women with late preterm labor will progress to delivery
  • Glover et al. (Amer J Perinatol, 2019) identified risk factors that are associated with late-preterm delivery in women with spontaneous late-preterm labor

METHODS:

  • Secondary analysis of Antenatal Betamethasone for Women at Risk for Late Preterm Delivery (ALPS) RCT (MFMU study)
  • Participants
    • Singleton pregnancies at 34w0d to 36w5d (betamethasone vs placebo)
  • Late preterm definition: 34w0d to 36w6d
  • Groups
    • Women who delivered at term
    • Women who delivered preterm
  • Data analysis
    • Optimal sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth were determined
    • Multivariable regression was used to identify factors associated with late preterm delivery

RESULTS:

  • 732 women with late preterm labor | 431 (59%) delivered preterm
  • Cervical dilation ≥ 4 cm for prediction of late-preterm delivery
    • 60% sensitivity | 68% specificity
    • AUC = 0.64 (95% CI, 0.61–0.68)
  • Cervical effacement ≥ 75% for prediction of late-preterm delivery
    •  59% sensitivity and 65% specificity
    • AUC = 0.62 (95% CI, 0.58–0.65)
  • Factors associated with late preterm delivery
    • Earlier gestational age at randomization: adjusted Odds Ratio (aOR) 0.8 (95% CI, 0.6 to 1; p=0.02)
    • Nulliparity: aOR 1.7 (95% CI, 1.1 to 2.6; p=0.01)
    • Fetal malpresentation: aOR 6.5 (95% CI, 0.8-53.6; 0.08)
  • Combining clinical and examination features significantly improved late preterm birth prediction
    • 81% sensitivity | 48% specificity
    • AUC = 0.72 (95% CI, 0.68–0.75; <0.01)

CONCLUSION:

  • 60% of women who experienced spontaneous late preterm labor will go on to deliver preterm
  • A combined analysis of examination and clinical features (e.g. gestational age, cervical dilation) improved the accuracy of late-preterm birth prediction but “overall models remained only modestly predictive”

Learn More – Primary Sources:

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

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Related ObG Topics:

Does Shortened Midtrimester Cervical Length Predict Preterm Birth?
The QUiPP Predictive Algorithm and Impact on Treatment for Preterm Birth
Does Cervical Length Actually Predict Preterm Birth?

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