Evaluation of Insulin-like Growth Factor-binding Protein-1 in Cervical Secreation as a Predictor of Preterm Delivery

Choi, June Seek; Yang, Jae Hyug; Ryu, Hyun Mee; Kim, Moon Young; Han, Jung Yeol; Ahn, Hyun Kyung; Shin, Joong Sik; Kim, Joo Oh; Moon, Myoung Jin; Chung, Jin Hoon; Lim, Ha Jung; Cho, Jun Hyung; Choi, Kyu Hong

Abstract

OBJECTIVE
This study is performed to assess whether detection of phosphorylated insulin like growth factor binding protein-1 (phIGFBP-1) in cervical secretions by a bed side test could be used to prediction preterm delivery in patient with regular uterine contraction.
METHODS
In our prospective study, 42 women between 20.2 and 36.4 weeks gestation with regular, persistent contraction (2-3/min for 30 min). and 27 women between 22.0 and 37.0 weeks of gestation without symptoms of preterm labor were assessed for presence of cervical phIGFBP-1. Dacron swabs were applied to the cervix and assayed in 5min by using immunochromatography, actim partus test (Medix Biochemica).
RESULTS
Of the 42 patients with regular uterine contractions, 22 had a positive actim partus test and 20 had a negative test. Among the 22 patients with positive test, 5 delivered preterm and other 17 patients delivered term (<37 weeks). Among the the 20 women with a negative test, 2 delivered preterm (NS). The mean concentration of phIGFBP-1 in 22 positive patients is 83.8+/-86.5 microgram/L and that in 20 negative patients is 2.1+/-5.0 microgram/L (P<0.0001) (Table 4). Sensitivity, specificity, false positive, false negative, positive predictive, and negative predictive values were 18.5, 59.6, 40.3, 28.6, 16.7, and 94.9%, respectively.
CONCLUSION
The absence of cervical phIGFBP-1 is seems to be a valuable test in excluding preterm delivery in patients who have regular uterine contractions. The high negative predictive value in this study may enable physicians to prevent over treatment of patients with uterine contractions. Therefore, many unwanted side-effects and complications of potentially hazardous tocolytic therapy can be prevented.