Strong predictors of spontaneous PTB <30 weeks in women with cerclage
Cervical length: Area under the ROC (AUC) 0.86 (95% CI, 0.79 to 0.94)
Fetal fibronectin: AUC 0.84 (95% CI, 0.75 to 0.92)
Cervical length and quantitative fetal fibronectin were stronger predictors of PTB <30 weeks in women with history-indicated cerclage, than for ultrasound-indicated cerclage, although both show clinical utility
History-indicated: AUC 0.95 (95% CI, 0.91 to 1.00)
Ultrasound-indicated: AUC 0.79 (95% CI, 0.66 to 0.91)
Quantitative fetal fibronectin
History-indicated: AUC 0.91 (95% CI, 0.75 to 1.00)
Ultrasound-indicated: AUC 0.76 (95% CI, 0.64 to 0.89)
There were no spontaneous deliveries <34 weeks in women with a transabdominal cerclage, so AUC could not be calculated
However, delivery was significantly delayed in this group (P<0.01)
For women with vaginal cerclage, cervical length and quantitative fetal fibronectin are useful predictors of spontaneous preterm birth
Prediction is most accurate in women with history-indicated cerclage
The authors state
If predictive utility is retained, tests could be used to support counselling e.g. stopping working or admission to hospital, alongside directing decision for time sensitive reactive therapies such a antenatal corticosteroids, in-utero transfer and magnesium sulphate
Clinicians should be reassured that tests can be relied upon to discriminate risk in women with cerclage and have utility to support management decisions for women at risk of treatment failure
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