CERVICOVAGINAL PLACENTAL ALPHA MICROGLOBULIN-1 FOR THE PREDICTION OF PRETERM BIRTH IN WOMEN WITH SUSPECTED PRETERM BIRTH

Background: Preterm birth is one of the most challenging and critical issues in obstetrics. Despite decades of study and therapeutic progress, roughly 10% of neonates are born prematurely. Early prediction of preterm labor allows for timely intervention (e.g. drug administration, neonatal intensive care unit preparation). One potential marker is placental Alpha microglubolin-1. It is a specific α-1 globulin secreted by decidual cells and amniotic epithelial cells early in pregnancy. It is associated with physiological changes occurring in the cervix and fetal membranes during labor and is predominantly found in high concentrations in amniotic fluid. Aim of study: To evaluate the role of cervicovaginal placental alpha microglobulin-1 for the prediction of the timing of spontaneous preterm birth. Patients and methods: This is an analytic cohort study that included 90 pregnant women presented with a suspicion of preterm labor and was conducted at the Gynecology and Obstetrics department of Baghdad Teaching Hospital/ Medical City, Baghdad. The study duration was from 1st of February 2024 to the end of November 2024. Inclusion criteria involved singleton pregnancy with intact membrane and cervical dilatation of ≤3 cm of gestational age (28 – 36 weeks + 6 days). Patients were categorized into four groups according to the time of delivery: Group I (preterm delivery within one week), group II (preterm delivery within two weeks), and group III (delivery after two weeks). All patients were test for placental alpha microglobulin-1 at time of admission. Results: Statistical analysis revealed that cervical placental alpha macroglobulin – 1 was a significant predictor of preterm delivery within 1 week, and 2 weeks. For predicting spontaneous preterm labor within 7 days, the optimal cut-off point was determined to be 6.46 ng/ml, resulting in a sensitivity of 98.6%, specificity of 88.9%, positive predictive value of 97.2%, and negative predictive value of 94.1%. Finally, the optimal threshold for predicting preterm labor within 14 days was established at 5.54 ng/ml, demonstrating a sensitivity of 96.2%, specificity of 100%, positive predictive value of 100.0%, and negative predictive value of 78.57%. Conclusion: Cervical placental alpha macroglobulin - 1 was shown to be a reliable predictor of the timing of spontaneous preterm birth in women suspected of preterm labor. Notably, it showed highest sensitivity and specificity within 1 week; and thus, effectively risk stratifying women who would be at risk of spontaneous preterm delivery within one week of symptom onset.