Labour induction at term: clinical, biophysical and molecular predictive factors.

PURPOSE: The aim of this multicentric study is to compare clinical, biophysical and molecular parameters in the prediction of the success of labour induction with prostaglandins. METHODS: We included 115 women, who underwent to labour induction at term with vaginal prostaglandin gel. We evaluated the diagnostic efficiency of endocervical phosphorylated insulin-like growth factor-binding protein (phIGFBP-1), cervicovaginal interleukins 6 (IL-6) and 8 (IL-8). We analyzed the transvaginal sonographic measurement of cervical length. A receiver-operating characteristics (ROC) curve was used to determine the most useful cut-off point. A multivariate logistic regression model was used to analyze the combination of significant predictive variables following univariate analysis. We analyzed all the data searching for the parameters that best predict the beginning of the active phase of labour within 12 h. RESULTS: 36.5 % of the patients delivered within 12 h. The Bishop score was >4 in the 43 % of patients with an active phase. The best cut-off values at ROC curves for cervical length, IL-6 and IL-8 were respectively 22 mm, 5 mg/dl and 20,237 mg/dl. At univariate analysis, all predictors of success, with the exception of IL-6, were significantly associated with the beginning of the active phase. Multivariate analysis of the Bishop score (OR 2.3), phIGFBP-1 test (OR 11.2) and IL-8 (OR 6.6) showed that the variables were independent and therefore useful in combination to predict the success of labour induction. CONCLUSION: The phIGFBP-1 test is a fast and easy test that can be used with Bishop score and IL-8 to reach an high positive predictive value in the prediction of the success of labour induction with prostaglandins.

Combination of biochemical markers in predicting pre-term delivery.

PURPOSE: The aim of this study was to evaluate the predictive performances of some biochemical markers in predicting pre-term delivery in asymptomatic women. METHODS: We included 491 asymptomatic women at 24 weeks' gestation, who underwent the endocervical phosphorylated insulin-like growth factor binding protein (phIGFBP-1) test, cervico-vaginal interleukins 6 (IL-6) and 8 (IL-8), and serum C-reactive protein (CRP). A receiver-operating characteristics (ROC) curve was used to determine the most useful cut off point. A multivariate logistic regression model was used in order to analyze the combination of significant predictive variables for pre-term delivery following univariate analysis. RESULTS: ROC curves indicated that 33 µg/l was the optimal cut off value for phIGFBP-1 test, 21.3 ng/l for IL-6, 324 ng/l for IL-8, and 8.42 mg/l for CRP in predicting pre-term delivery. The univariate logistic regression analyses revealed an odds ratio of 3.04 for phIGFBP-1 test, 4.82 for IL-6, and 3.08 for CRP. The multivariate analysis of phIGFBP-1 test, IL-6, and CRP showed that they were independent variables and therefore useful in combination for predicting pre-term delivery. CONCLUSIONS: The phIGFBP-1 test, the cervico-vaginal IL-6, and the serum CRP are independent variables that can be used together to predict pre-term delivery in asymptomatic women.