Association between Features of Spontaneous Late Preterm Labor and Late Preterm Birth

Angelica V. Glover*, Ashley N. Battarbee, Cynthia Gyamfi-Bannerman, Kim A. Boggess, Grecio Sandoval, Sean C. Blackwell, Alan T.N. Tita, Uma M. Reddy, Lucky Jain, George R. Saade, Dwight J. Rouse, Jay D. Iams, Erin A.S. Clark, Edward K. Chien, Alan M. Peaceman, Ronald S. Gibbs, Geeta K. Swamy, Mary E. Norton, Brian M. Casey, Steve N. CaritisJorge E. Tolosa, Yoram Sorokin, Tracy A. Manuck

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective This study aimed to evaluate the association between clinical and examination features at admission and late preterm birth. Study Design The present study is a secondary analysis of a randomized trial of singleton pregnancies at 34 0/7 to 36 5/7 weeks' gestation. We included women in spontaneous preterm labor with intact membranes and compared them by gestational age at delivery (preterm vs. term). We calculated a statistical cut-point optimizing the sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth and used multivariable regression to identify factors associated with late preterm delivery. Results A total of 431 out of 732 (59%) women delivered preterm. Cervical dilation ≥ 4 cm was 60% sensitive and 68% specific for late preterm birth. Cervical effacement ≥ 75% was 59% sensitive and 65% specific for late preterm birth. Earlier gestational age at randomization, nulliparity, and fetal malpresentation were associated with late preterm birth. The final regression model including clinical and examination features significantly improved late preterm birth prediction (81% sensitivity, 48% specificity, area under the curve = 0.72, 95% confidence interval [CI]: 0.68-0.75, and p -value < 0.01). Conclusion Four in 10 women in late-preterm labor subsequently delivered at term. Combination of examination and clinical features (including parity and gestational age) improved late-preterm birth prediction.

Original languageEnglish (US)
Pages (from-to)357-364
Number of pages8
JournalAmerican journal of perinatology
Volume37
Issue number4
DOIs
StatePublished - Mar 1 2020

Funding

We performed all statistical analyses using STATA/SE, Version 14.1 (StataCorp, Inc., College Station, TX). p-Value < 0.05 was considered statistically significant. All women provided written, informed consent for the original trial at their local center. We performed this secondary analysis using a deidentified dataset under a waiver of informed consent approved by the Institutional Review Board at the University of North Carolina at Chapel Hill. This study was supported by grants (HL098554 and HL098354) from the National Heart, Lung, and Blood Institute (NHLBI), by grants (HD21410, HD27915, HD27917, HD27869, HD34116, HD34208, HD40485, HD40500, HD40512, HD40544, HD40545, HD40560, HD53097, HD53118, HD68268, HD68258, HD68282, and HD36801) from the National Institute of Child This study was supported by grants (HL098554 and HL098354) from the NHLBI, by grants (HD21410, HD27915, HD27917, HD27869, HD34116, HD34208, HD40485, HD40500, HD40512, HD40544, HD40545, HD40560, HD53097, HD53118, HD68268, HD68258, HD68282, and HD36801) from the NICHD, and by a grant (UL1 TR000040) from the National Center for Advancing Translational Sciences, National Institutes of Health. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Institutes of Health. Health and Human Development (NICHD), and by a grant (UL1 TR000040) from the National Center for Advancing Translational Sciences, National Institutes of Health.

Keywords

  • ALPS
  • late preterm birth
  • prediction
  • preterm labor
  • spontaneous labor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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