Angelica V Glover1, Ashley N Battarbee1, Cynthia Gyamfi-Bannerman2, Kim A Boggess1, Grecio Sandoval3, Sean C Blackwell4, Alan T N Tita5, Uma M Reddy6, Lucky Jain7, George R Saade8, Dwight J Rouse9, Jay D Iams10, Erin A S Clark11, Edward K Chien12, Alan M Peaceman13, Ronald S Gibbs14, Geeta K Swamy15, Mary E Norton16, Brian M Casey17, Steve N Caritis18, Jorge E Tolosa19, Yoram Sorokin20, Tracy A Manuck1. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Department of Obstetrics and Gynecology, Columbia University, New York, New York. 3. George Washington University Biostatistics Center, Washington, District of Columbia. 4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas. 5. Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama. 6. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland. 7. Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia. 8. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas. 9. Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island. 10. Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio. 11. Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah. 12. MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. 13. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois. 14. Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado. 15. Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina. 16. Department of Obstetrics and Gynecology, Stanford University, Stanford, California. 17. Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, Texas. 18. Department of Obstetrics and Gynecology, University of Pittsburg, Pittsburg, Pennsylvania. 19. Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon. 20. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.
Abstract
OBJECTIVE: This study aimed to evaluate the association between clinical and examination features at admission and late preterm birth. STUDY DESIGN: The present study is a secondary analysis of a randomized trial of singleton pregnancies at 340/7 to 365/7 weeks' gestation. We included women in spontaneous preterm labor with intact membranes and compared them by gestational age at delivery (preterm vs. term). We calculated a statistical cut-point optimizing the sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth and used multivariable regression to identify factors associated with late preterm delivery. RESULTS:A total of 431 out of 732 (59%) women delivered preterm. Cervical dilation ≥ 4 cm was 60% sensitive and 68% specific for late preterm birth. Cervical effacement ≥ 75% was 59% sensitive and 65% specific for late preterm birth. Earlier gestational age at randomization, nulliparity, and fetal malpresentation were associated with late preterm birth. The final regression model including clinical and examination features significantly improved late preterm birth prediction (81% sensitivity, 48% specificity, area under the curve = 0.72, 95% confidence interval [CI]: 0.68-0.75, and p-value < 0.01). CONCLUSION: Four in 10 women in late-preterm labor subsequently delivered at term. Combination of examination and clinical features (including parity and gestational age) improved late-preterm birth prediction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
RCT Entities:
OBJECTIVE: This study aimed to evaluate the association between clinical and examination features at admission and late preterm birth. STUDY DESIGN: The present study is a secondary analysis of a randomized trial of singleton pregnancies at 340/7 to 365/7 weeks' gestation. We included women in spontaneous preterm labor with intact membranes and compared them by gestational age at delivery (preterm vs. term). We calculated a statistical cut-point optimizing the sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth and used multivariable regression to identify factors associated with late preterm delivery. RESULTS: A total of 431 out of 732 (59%) women delivered preterm. Cervical dilation ≥ 4 cm was 60% sensitive and 68% specific for late preterm birth. Cervical effacement ≥ 75% was 59% sensitive and 65% specific for late preterm birth. Earlier gestational age at randomization, nulliparity, and fetal malpresentation were associated with late preterm birth. The final regression model including clinical and examination features significantly improved late preterm birth prediction (81% sensitivity, 48% specificity, area under the curve = 0.72, 95% confidence interval [CI]: 0.68-0.75, and p-value < 0.01). CONCLUSION: Four in 10 women in late-preterm labor subsequently delivered at term. Combination of examination and clinical features (including parity and gestational age) improved late-preterm birth prediction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Jamie A Bastek; Mary D Sammel; Sindhu K Srinivas; Meghan A McShea; Markley N Foreman; Michal A Elovitz; Joshua P Metlay Journal: Obstet Gynecol Date: 2012-06 Impact factor: 7.661
Authors: J D Iams; R L Goldenberg; B M Mercer; A H Moawad; P J Meis; A F Das; S N Caritis; M Miodovnik; M K Menard; G R Thurnau; M P Dombrowski; J H Roberts Journal: Am J Obstet Gynecol Date: 2001-03 Impact factor: 8.661
Authors: M Sean Esplin; Michal A Elovitz; Jay D Iams; Corette B Parker; Ronald J Wapner; William A Grobman; Hyagriv N Simhan; Deborah A Wing; David M Haas; Robert M Silver; Matthew K Hoffman; Alan M Peaceman; Steve N Caritis; Samuel Parry; Pathik Wadhwa; Tatiana Foroud; Brian M Mercer; Shannon M Hunter; George R Saade; Uma M Reddy Journal: JAMA Date: 2017-03-14 Impact factor: 56.272
Authors: G G Donders; K Van Calsteren; G Bellen; R Reybrouck; T Van den Bosch; I Riphagen; S Van Lierde Journal: BJOG Date: 2009-06-17 Impact factor: 6.531
Authors: R B Newman; R L Goldenberg; J D Iams; P J Meis; B M Mercer; A H Moawad; E Thom; M Miodovnik; S N Caritis; M Dombrowski Journal: Obstet Gynecol Date: 2008-09 Impact factor: 7.661
Authors: Cynthia Gyamfi-Bannerman; Elizabeth A Thom; Sean C Blackwell; Alan T N Tita; Uma M Reddy; George R Saade; Dwight J Rouse; David S McKenna; Erin A S Clark; John M Thorp; Edward K Chien; Alan M Peaceman; Ronald S Gibbs; Geeta K Swamy; Mary E Norton; Brian M Casey; Steve N Caritis; Jorge E Tolosa; Yoram Sorokin; J Peter VanDorsten; Lucky Jain Journal: N Engl J Med Date: 2016-02-04 Impact factor: 91.245