[Prediction of premature labor--multifactorial analysis of a prospective clinical study].

Objective: To evaluate, which of selected anamnestic, laboratory and ultrasonographic (USG) parameters could contribute to the prediction of prematurity.

Design: Prospective, observational, clinical study.

Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague.

Methods: 349 women with the singleton pregnancy were followed from the half of the 2nd trimester until the end of gestation. At each woman the anamnestic (age, parity, pregravid BMI, weight gain until 20th week, significant risk from patient's history, cigarette smoking, risk pregnancy symptoms until 20th week), laboratory (maternal serum concentration of AFP, hCG, and uE3/triple test/at 16th week, the blood count and ferritin concentration at 18th-20th week, bacteriological cultivation of the smear from the cervix at 34th-36th week), and USG (transvaginal cervicometry and doppler flowmetry of the uterine arteries at 18th-20th week) data were established. With the aid of one-dimensional and multi-dimensional analysis the dependence of completed gestational age and preterm delivery (before completed 37th week) on above mentioned parameters was tested.

Results: 314 women completed the study. We proved a significant dependence of prematurity on the following markers: risk pregnancy symptoms until 20th week (RR 2.94), abnormal triple test (RR 4.63), cultivation of pathogens from the cervix (RR 5.49), USG established cervical length (P < 0.0001), abnormal result of cervicometry (RR 19.02), both doppler parameters (RI of uterine arteries: P < 0.0001; presence of early diastolic notch: RR 2.84). The results of multi-dimensional analysis confirmed superiority of USG cervicometry in prediction of both measured outcomes.

Conclusion: The predictive value of some of selected anamnestic, laboratory, and USG markers of premature delivery was proved at random population of women with singleton pregnancy. The abnormal result of transvaginal USG cervicometry was the most significant predictor of prematurity. We recommend a routine performing of cervicometry (as a part of USG screening at 18th-20th week) for early selection of women with significantly increased risk of prematurity.