Preterm Delivery: Predictive Value of Salivary Estriol, and Alpha Feto Protien (original) (raw)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Preterm birth defined as any delivery at less than 37 completed weeks of gestation (< 259 days). The lower limit of viability being generally accepted to be at 23 completed weeks. Preterm birth is a heterogeneous condition; up to 30-40% of all cases of preterm birth are the results of elective delivery for a maternal or a fetal complication. The remaining 60-70% of preterm birth is probably the result of covert or sub-clinical infective/ inflammatory processes, cervical dysfunction, idiopathic (unknown causes), multiple gestations and possible social, nutritional and environment interaction. 1 This report focuses on this latter group of so-called, spontaneous preterm births. The diagnosis of preterm labour which precedes preterm delivery has been traditionally based on clinical indicators, including a history of preterm birth, symptoms and clinical examination. Progesterone is essential for maintenance of pregnancy and promote uterine relaxation
The Salivary Estriol Level was Higher in Preterm Delivery Compared to that in Preterm Pregnancy
Indonesian Journal of Obstetrics and Gynecology, 2013
Preterm delivery is a problem in the field of obstetry and perinatology due to the high incidence of infant morbidity and mortality. Seventy percents of neonatal mortality and morbidity were caused by prematurity, with the mortality rate of 19,000. Prematurity is also as the most important risk factor for neurologic disorder and infant developmental disorder. 1-5 The incidence rate of preterm delivery is 7-10% (mean, 11%) of overall pregnancy. 3 In the United States, the incidence rate of preterm delivery is 12% and it causes 75% of neonatal death, whereas in the developing countries, the incidence ranges from 5% to 10%. 3,6 In Indonesia, the prematurity incidence ranges from 10 to 20%; while from January 1998 to December 2000, at Dr. Hasan Sadikin Hospital Bandung, it was 8.2% of overall delivery with perinatal death rate by 53.6%. 5-7
BJOG: An International Journal of Obstetrics & Gynaecology, 2009
Saliva progesterone and oestriol concentrations were determined weekly from 24 weeks of gestation in women at increased risk of preterm delivery. Samples were analysed from 28 women with spontaneous onset of labour and delivery before 37 weeks of gestation, and 64 who delivered at term. Saliva progesterone was lower in the 12 women delivering before 34 weeks than in those delivering later, between 34 and 37 weeks (P = 0.007) or at term (P = 0.009). Measurement of saliva progesterone may be of value in the prediction of early preterm labour and in determining which women might benefit from progesterone supplementation.
Salivary progesterone and cervical length measurement as predictors of spontaneous preterm birth
Objective: To evaluate the efficacy of salivary progesterone, cervical length measurement in predicting preterm birth (PTB). Methods: Prospective observational study included 240 pregnant women with gestational age (GA) 26–34 weeks classified into two equal groups; group one are high risk for PTB (those with symptoms of uterine contractions or history of one or more spontaneous preterm delivery or second trimester abortion) and group 2 are controls. Results: There was a highly significant difference between the two study groups regarding GA at delivery (31.3 ± 3.75 in high risk versus 38.5 ± 1.3 in control), cervical length measured by transvaginal ultrasound (24.7 ± 8.6 in high risk versus 40.1 ± 4.67 in control) and salivary progesterone level (728.9 ± 222.3 in high risk versus 1099.9 ± 189.4 in control; p50.001). There was a statistically significant difference between levels of salivary progesterone at different GA among the high risk group (p value 0.035) but not in low risk group (p value 0.492). CL measurement showed a sensitivity of 71.5% with 100% specificity, 100% PPV, 69.97% NPV and accuracy of 83%, while salivary progesterone showed a sensitivity of 84% with 90% specificity, 89.8% PPV, 85.9% NPV and accuracy of 92.2%. Conclusion: The measurement of both salivary progesterone and cervical length are good predictors for development of PTB.
Oral Versus Vaginal Progesterone In Preterm Labor
Evidence Based Women's Health Journal, 2018
Background: Preterm labor (PTL) remains a distressing issue in modern obstetrics, and still associated with poor impact on the perinatal outcomes worldwide. Progesterone plays a vital role in preventing the PTL. Objective: To compare different route of progesterone administration on the perinatal outcomes. Patients and Methods: It was a prospective comparative clinical trial, conducted at Suez Canal University Hospitals, Ismailia from December 2015 to January 2017. One hundred and thirty eight pregnant patients were selected at 20-24 weeks gestation´ at risk of PTL and were classified into: 72 women received oral dydrogesterone 10 mg twice a day [Duphastone®] (Oral group) and 66 women received vaginal progesterone 200 mg vaginally twice a day [Prontogest®] (vaginal group). The primary outcome measures were gestational age at delivery in weeks, birth weight in grams, Apgar score at 1 and 5 minutes, the need for neonatal intensive care unit admission and neonatal mortality. Results: There was a significant difference between both group in favor to the vaginal group in all the studied outcome measures (p value < 0.05) with the exception of the Apgar score at 5 minutes post delivery (p value = 0.1). No cases of perinatal mortality in the vaginal group and only 3 cases in the oral group. Conclusion: The vaginal route is of better and significant results.
Salivary oestriol in normal and abnormal pregnancies
Bjog-an International Journal of Obstetrics and Gynaecology, 1984
Summary. Profiles of daily salivary oestriol concentrations throughout the third trimester of pregnancy have been constructed for 14 normal and 11 abnormal pregnancies. Day-to-day variations were significantly higher than those reported for unconjugated oestriol in plasma or serum. A sustained decline in salivary oestriol concentrations was observed in one pregnancy in which intrauterine death occurred. Sustained falls were also observed in two pregnancies in which a healthy infant was born at term. In all other patients a normal salivary oestriol profile correlated with a favourable outcome. Salivary oestriol measurements provide similar information to plasma unconjugated oestriol measurements while offering the advantages of a simple, non-invasive sample collection procedure.
Reproductive Health, 2018
Background: In India, 3.6 million pregnancies are affected by preterm birth annually, with many infants dying or surviving with disability. Currently, there is no simple test available for screening all women at risk of spontaneous PTB in low income setting, although high resource settings routinely use cervical length measurement and cervicovaginal fluid fetal fibronectin for identification and care of women at risk due to clinical history. In rural India, where the public health system has limited infrastructure, trained staff and equipment, there is a greater need to develop a low-cost screening approach for providing early referral, treatment and remedial support for pregnant women at risk of preterm birth. There is interest in the use of a salivary progesterone test as a screening tool preliminary evidence from India, Egypt and UK has shown promise for this type of test. The test requires further validation in a low resource community setting. Methods: The Promises study aims to validate and test the feasibility of introducing a low-cost salivary progesterone preterm birth prediction test in two rural districts in India with high rates of prematurity. It is a prospective study of 2000 pregnant women recruited from Panna and Satna in Madhya Pradesh over approximately 24 months. Demographic and pregnancy outcome data will be collected, and pregnancies will be dated by ultrasound sonography. Saliva progesterone will be measured by ELISA in samples obtained between 24-28 weeks of gestation. The association between salivary progesterone and preterm birth will be determined and the utility of salivary progesterone to predict preterm birth < 34, as well as < 30 and < 37 weeks assessed. Additional qualitative data will be obtained in terms of acceptability and feasibility of saliva progesterone testing and knowledge of PTB. Discussion: A validated cost-effective saliva test, which has potential for further adaptation to a 'point of care' setting will allow early identification of pregnant women at risk of preterm birth, who can be linked to an effective pathway of care and support to reduce preterm birth and associated adverse consequences. This will reduce both economic and emotional burden on the affected women and their families.