Prediction of delivery among women with early preterm labor by means of clinical characteristics alone.
Am J Obstet Gynecol
; 181(6): 1414-8, 1999 Dec.
Article
em En
| MEDLINE
| ID: mdl-10601922
ABSTRACT
OBJECTIVE:
This study was undertaken to assess whether individual clinical factors or combinations thereof could be used to accurately predict the risk of delivery within 1 week of admission among women with preterm labor and minimal cervical dilatation. STUDYDESIGN:
We performed a case-control study of patients admitted to our institution with preterm labor and minimal cervical dilatation. A case patient was a patient who sought treatment with uterine contractions between 24 and 34 weeks' gestation with cervical dilatation =2 cm, who received tocolysis with magnesium sulfate, and who was delivered within 7 days of admission. Control subjects were those who had the same presentation with preterm labor but were not delivered within the first 7 days after admission. The medical records of case patients and control subjects were then abstracted, and information on >70 potential predictors was recorded. Statistical analysis consisted of bivariate and multivariable methods. We also generated a multivariable clinical predictive model with the purpose of detecting a proportion as high as possible of those destined to be delivered within 1 week (high sensitivity). We estimated that we would need 50 case patients and 150 control subjects to detect an odds ratio of 2.5 for risk factors with a prevalence of 20%, an alpha error of.05, a beta error of.20, and a control subject/case patient ratio of 31.RESULTS:
Three variables were eligible for inclusion in our logistic models according to the bivariate analyses-bleeding on admission, substance abuse, and admission white blood cell count >/=14,000 cells/microL. The simplest and most favorable model included only 2 variables, bleeding and substance abuse, and yielded a sensitivity of 46% and a specificity of 76%. The full 3-variable model had similar test characteristics. For no model were we able to achieve a sensitivity >/=50%.CONCLUSION:
The results of this case-control study suggest that combinations of clinical factors do not yield an adequate level of discrimination to be used alone for predicting the likelihood of delivery within 1 week among patients with minimal degrees of cervical dilatation.
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Base de dados:
MEDLINE
Assunto principal:
Exame Físico
/
Trabalho de Parto Prematuro
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
/
Pregnancy
Idioma:
En
Ano de publicação:
1999
Tipo de documento:
Article