The following are excerpts of the latest guidelines by the European Association of Perinatal Medicine1 combining the most recent evidence with a European expert view of the problem of preterm labor and birth management.

Key Points and Recommendations

Methods to identify symptomatic women at risk for Spontaneous Preterm Delivery

“Before undertaking any therapeutic strategy, careful identification of women at risk for preterm labor and delivery is needed, so as to detect manageable conditions and fetal and/or maternal contraindications.“

“The use of cervical length measurements and of biochemical markers, especially if combined, improves identification of patients at risk for imminent spontaneous PTD as compared to clinical symptoms alone (i.e. vaginal bleeding, contraction frequency/duration, cervical dilation, etc.).“

“Of the available biochemical tests, that based on fetal fibronectin (fFN) has been the best characterized. However, the value of this test, like that of phosphorylated insulin-like growth factor protein-1 (phIGFBP-1) and cervical length (CL) measurement alone, may be limited only to its negative predictive value (NPV), given its poor positive predictive value (PPV).“

“In patients where the CL is between 1.5 and 3.0 cm, we recommend the use of a biomarker test with the highest combination of NPV and PPV that can be run shortly after a vaginal examination. According to recent literature, this test seems to be that based on placental alpha-microglobulin-1 (PAMG-1 Partosure).“

Placental alpha macroglobulin (PAMG-1)

“The PAMG-1 biomarker has shown (itself) to be useful in diagnosing cases where CL is between 15 and 30 mm where the predictive value of CL is lowest.“

“This may indicate that when results are acted upon consistently, the use of the PAMG-1 biomarker in conjunction with cervical length measurement, could provide both clinical and economic benefits.“

Fetal fibronectin (fFN)

“In symptomatic women, both qualitative and quantitative fetal fibronectin in cervico-vaginal secretions have been separately shown not to improve the prediction of delivery within 7 days compared to the sonographic measurement of cervical length.“

Quantitative fFN detection

“(…)while one study has demonstrated enhanced clinical utility compared with the traditional qualitative test (Abbott), another has concluded that quantitative fFN testing does not improve the prediction of PTB within 7 days compared with qualitative fFN testing in combination with CL measurement in terms of reclassification from high to low (<5%) risk.“

Phosphorylated insulin-like growth factor binding protein (phIGFBP-1)

“A negative test result had a low to moderate accuracy to identify women who were not at risk for delivering within the next 48 hours (…).“

Table 1. Biochemical marker tests to predict spontaneous PTD within 7 days of testing in women with symptoms of preterm labor

  1. GC Di Renzo et al. The Journal of Maternal-Fetal & Neonatal Medicine, 2017. 08 May 2017. DOI: 10.1080/14767058.2017.1323860