Biochemical markers (without markers of infection) of the risk of preterm delivery Implications for clinical practice

Background: New biochemical markers for the risk of spontaneous preterm bir th (SPB) give a more precise and earlier diagnosis than the usual ones. We reviewed the data about the principal markers. Results: Using studies with good methodology and a large number of subjects, we observe that the predic tive value of these new markers is somewhat higher than those of the usual markers. Fetal fibro-nectin (FNf) and cervical ultrasound undeniably improv e the identification of patients at risk of preterm birth, both in the gene ral population and in these threatened preterm delivery. However no managem ent has yet been demonstrated efficacious, especially in a general populati on so any recommendations fur their systematic utilisation is premature. Ot her biochemical markers (salivary estriol, serum CRH, etc.) are still under assessment and should not be used outside research protocols. Implication for practice: It is appropriate To integrate tither FNf or cervical ultraso und into daily clinical practice for patients with signs of preterm labor. These new indicators are of special use when the diagnosis is uncertain wit h the standard markers (uterine contractions, digital examination). Among t hese patients, they should reduce the number of hospitalizations and of use less treatments, because of their good negative predictive value. At the sa me time. for patients poorly 'labeled' by the clinical examination, they sh ould allow the application of intensive management (intravenous tocolysis, corticoids, in utero transfers). Conclusion: Future studies should evaluate these tests: in everyday practice. The objective is not to predict preterm birth but to prevent either it or its negative consequences. This goal wil l be met when we have an effective treatment, without associated adverse ef fects, to offer patients after a positive test result. (C) 2001 Elsevier Sc ience Ireland Ltd. All rights reserved.