Secondary predictors of preterm labour

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Preterm birth prediction is crucial for obstetric care.
• Secondary predictors enhance individual risk assessment beyond primary factors.
• Fetal fibronectin (FFN) and cervical shortening are key secondary predictors.

Purpose of the Study:

• To review the role and effectiveness of secondary predictors in assessing preterm birth risk.
• To discuss the utility of intrauterine infection markers.
• To evaluate the current application of these markers in clinical practice.

Main Methods:

• Review of established secondary predictors: fetal fibronectin (FFN), transvaginal ultrasonography for cervical length.
• Inclusion of markers for intrauterine infection: bacterial vaginosis (BV), IL-6, IL-8, ferritin, G-CSF.
• Analysis of studies on marker combinations, serial testing, and intervention effectiveness.

Main Results:

• FFN and cervical shortening are strong short-term predictors of preterm birth.
• Intrauterine infection markers (BV, inflammatory cytokines) also indicate risk.
• Single marker sensitivity is moderate; combined or serial testing shows limited improvement.
• Intervention studies yield mixed benefits, limiting routine screening recommendations.

Conclusions:

• Secondary predictors are valuable for assessing individual preterm birth risk, especially in high-risk populations.
• Current evidence does not support routine screening of low-risk pregnancies with these markers.
• Future use focuses on designing targeted intervention studies and refining management for high-risk women.