Cervicovaginal Fluid Beta Human Chorionic Gonadotropin Assay as an Early Predictor of Spontaneous Preterm Delivery among Antenatal Patients
Keywords:Preterm delivery, risk factors, cervicovaginal fluid, quantitative assay, Nigeria
Background: The aim of this study was to assess the usefulness of the beta subunit of hCG in cervicovaginal secretions as a biochemical predictor of spontaneous preterm delivery among pregnant women with and without preterm delivery risk.
Design: This was an eight-month prospective case control study of pregnant women with or without risk factors for preterm delivery.
Setting: Ifako- Ijaye General Hospital Lagos/ Lagos State University Teaching Hospital, Ikeja Lagos Nigeria.
Participants: 150 pregnant women which consisted of 50 cases with preterm delivery risk and 100 controls without preterm delivery risk.
Interventions: A structured interviewer administered questionnaire which had been pretested, was used to collect data. Two cervicovaginal fluid samples at 26 weeks and 32 weeks were collected from each of the participants and it was quantitatively assayed using ELISA for presence of beta hCG. The participants were followed up till delivery.
Results: 15 participants out of the 50 cases delivered their babies preterm, while only 2 participants out of the 100 controls had preterm delivery. The 15 cases who delivered preterm had significant increase in their mean beta HCG value from 7.44±1.74 at 26 weeks to 32.6±1.32 at 32 weeks with p value<0.001. There was however no statistical difference in the mean beta HCG at 26 weeks and at 32 weeks for the control group.
Conclusion: The concentration of beta HCG in the cervicovaginal fluid is a useful early predictor of preterm delivery especially among patients with risk factors.
Preterm birth. World Health Organisation. http://www. Who.- Int/ media centre Fact sheet N 363, Nov. 2014. (Accessed on March 2015).
Onyaye E, Olowu K, Peterside O, Adeyemi O. Prevalence and outcome of Preterm Admissions at the Neonatal unit of a Tertiary Health Centre in Southern Nigeria .Open Journal of Paediatrics, 2014; 4:67-75.
Blencowe H, Cousens S, Oestergaard M .Z, Muller A. B, Chou D. National, Regional and Worldwide estimates of preterm birth rates in the year 2010 with trends since 1990 for selected countries. A systematic analysis and implications, Lancet 2012; 379: 2162-72.
Marie Holst R. Cervical and Intra amniotic markers of Preterm birth and infection. Institute of Clinical Sciences at Sahlgrenska Academy, University of Gathenburg Sweden, 2009.
Minoo Ranjbar , Najmeh Tehranian , Anoshiravan Kazemnejad, Saeideh Ziaei. A Survey of beta hcG in Cervicovaginal secretions as a predictor of preterm delivery. Annals of biological Research , 2012,3:4644-4649.
Chadiramani M, Di Renzo, Gian Carlo, Henrich W. Fetal fibronectin as a predictor of spontaneous preterm birth: An European perspective. The journal of maternal – fetal and neonatal medicine, 2011; 24: 330- 336.
Mokuolu O A, Suleiman B M. Prevalence and determinants of preterm deliveries in the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Pediatric Rep. June 18, 2010;2(1) :e3.Published online June 18, 2010 doi:10481/Pr 2010.e3.
Iams J D. Clinical Practice Prevention of Preterm Parturition. The N Engl J of Med 2014, 370: 254-261.
Goldenberg R. L, Culhane J F, Iams J D, Romero R. Epidermiology and causes of preterm birth. The Lancet ,2008; 371: 75-84.
Behriman R E and Butler Stith A. Preterm Birth: Causes, Consequences and Prevention. The National Academies Press, Washington, DC, USA, 2007.
Romero R, Velez Edwards D R , Kusanovic J P. Identification of fetal and maternal single nucleotide polymorphisms in candidate genes that predispose to sponteneous preterm labour with intact membranes. AJOG 2010;202:431.
Lockwood C J, Senyei A E, Dische M R, Casal D, Shah K D, Thung S W, et al. Fetal fibronectin in cervical and vaginal secretions defines a patient population at high risk for preterm delivery. N Engl J Med 1991;324:669-74.
Bhawna Singh, Binita Goswami . Potential biochemical markers for preterm labour. A pilot study in North India. Ind J Clin. Biochem, 2011;26:41-45.
Preterm birth. In Wikipedia, 2014. Available from: http://en. m. wikipedia. org/ wiki preterm birth, 2014. (Accessed on March 2015).
Preterm Birth. WHO preterm birth fact sheet, Geneva, 2012. Available from:
http://www.who.int/media centre/fact sheet/fs363/en/2012. ( Accessed on April 2015).
Goldenberg R L, Goepfert A R and Ramsey P S. Biochemical markers for the prediction of preterm birth. American Journal of Obstetrics and Gynaecology, 2005; 192: 536-546.
Goldenberg R L, Iams J D, Mercer B M . What we have learnt about the predictors of preterm birth. Seminars in Perinatology, 2003; 27: 185-193.
Howson Edscp, Kinney M V, Lawn J E. Born too soon. The Global Action Report on Preterm birth, WHO, Geneva, 2012.
Gayathri Rengaraj, Kiran Gulena. Beta hCG in cervicovaginal secretions as a predictor of preterm birth. Gynecol Obstet. Invest 2009; 67:202-207.
Conde-Agudelo A, Papageorghiou A T, Kennedy S H, Villar J. Novel biomarkers for the prediction of sponteneous preterm birth phenotype: a systematic review and meta – analysis . BJOG 2011; 118:1042-1054.
Guvenal T, Kantas E, Erselcan T, Cetin A, Culhaoglu Y. Beta human chorionic gonadotropin and prolactin assays in cervicovaginal secretions as a predictor of preterm delivery. Int J Gynecol Obstet. 2001; 75:229-34.
Sak Erdal M, Sak Bel S, Talip Gul. Beta human chorionic gonadotropin concentration in cervicovaginal secretions as an early marker of preterm delivery. J Clin Exp Invest,2010;1.
Stefan C Kane, Fabrico da Silva, Costa Shaun Brennecke. First Trimester Biomarkers in the Prediction of later pregnancy complications. Hindawi Publishing Corporation. BioMed Research International, Vol 2014, Article ID 807196.
Honest H, Forbes C A . Screening to prevent spontaneous preterm birth. Systematic reviews of accuracy and effectiveness literature with economic modelling. Health Technology Assessment, 2009; 13:43.
Balu R B, Savitz D A, Ananth C V. “Bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth,” Obstetrics and Gynecology,2003;101:862-868.
Martin J A , Sutton P D, Ventura S J , Menacker F and Kirmeyer S. Births: Final data for
in National Vital Statistics Reports, National Center for health Statistics, Hyattsville, Md, USA ,2009.
Behrman R E and Butler Stith A. Preterm Birth: Causes Consequences, and Prevention, The National Academies Press, Washington, DC, USA, 2007.
Branum A M and Schoendorf K C. “The influence of maternal age on very preterm birth of twins: differential effects by parity,”Paediatric and Perinatal Epidemiology,2005;19:399404.
Mercer B M, Mercer B M, Goldenberg R L. “The Preterm Prediction Study: Effect of gestational age and cause of preterm birth on subsequent obstetric outcome. National Institute of Child Health and Human Development Maternal- Fetal Medicine Units Network,” American Journal of Obstetrics & Gynaecology, 1999; 181: 1216-1221.
Goldenberg R L, Hauth J C, and Andrews W W. “Intrauterine Infection and preterm delivery,” N Engl J of Med, 2000 ; 342: 1500-1507.
Knox I C Jr. and Hoerner J K. “The role of infection in premature rupture of the membranes,” AJOG, 1950; 59:190-194.
Menon R, Torloni M R, Voltolini C. “Biomarkers of spontaneous preterm birth: An overview of the literature in the last four decades,” Reproductive Sciences, 2011; 18 :10461070.
Goepfert A R, Goldenberg R L, Andrews W W, “The Preterm Prediction Study: Association between cervical interleukin 6 concentration and spontaneous preterm birth,” AJOG,2001; 184:483-488.
Wei S, Fraser W and Luo Z. “Inflammatory cytokines and spontaneous preterm birth in asymptomatic women: a systematic review,” Obstetrics and Gynaecology,2010;116:393401.
Paternoster D M, Stella A, Gerace P. “Biochemical markers for the prediction of spontaneous pre-term birth,” Int J of Gynae and Obstet, 2002;79:123-129.
Kramer M S, Kahn S R, Platt R W. “Mid-trimester maternal plasma cytokines and CRP as predictors of spontaneous preterm birth,” Cytokine, 2010;49:10-14.
Goldenberg R L, Iams J D, Mercer B M . “The Preterm Prediction Study: Toward a multiple-marker test for spontaneous preterm birth,” AJOG,2001;185:643-651.
Hvilsom G B, Thorsen P, Jeune B, and Bakketeig L S. “C reactive protein: A serological marker for preterm delivery?” Acta Obstetricia et Gynecologica Scandinavica,2002;81:424-429.
Catov J M, Bodnar L M, Ness R B, Barron S J, and Roberts J M. “Inflammation and dyslipidemia related to risk of spontaneous preterm birth”. American Journal of Epidemiology, 2007;166:1312-1319.
Riboni F, Vitulo A, Plebani M, Dell’avanzo M, Battagliarin G, and Paternoster D. “Combination of biochemical markers in predicting pre-term delivery,” Archives of Gynecology and Obstetrics,2012;285:61-66.
Roman A S, Koklanaris N, Paidas M J, Mulholland J, Levitz M, and Rebarber A. “Blind vaginal fetal fibronectin as a predictor of spontaneous preterm delivery,” Obstetrics and Gynecology,2005; 105:285-289.
Honest H, Bachmann L M, Gupta J K, Kleijnen J, and Khan K S. “Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review,” British Med J,2002;325:301-304.
Yeast J D and Lu G. “Biochemical markers for the prediction of preterm labor,” Obstetrics and Gynecology Clinics of North America,2005;32:369-381.
Berkowitz G S, Lapinski R H, Lockwood C J, Florio P, Blackmore-Prince C, and Petraglia F. “Corticotropin-releasing factor and its binding protein: Maternal serum levels in term and preterm deliveries.” AJOG,1996; 174:1477-1483.
Garshasbi A, Ghazanfari T, and Faghih Zadeh S. “Beta-human chorionic gonadotropin in cervicovaginal secretions and preterm delivery”. Int J of Gynae and Obstet, 2004; 86:358364.
Moawad A H, Goldenberg R L, Mercer B . “The Preterm Prediction Study: the value of serum alkaline phosphatase, alpha-fetoprotein, plasma corticotropin-releasing hormone, and other serum markers for the prediction of spontaneous preterm birth.” AJOG 2002;
Ramsey P S and Andrews W W. “Biochemical predictors of preterm labor: fetal fibronectin and salivary estriol”. Clinics in Perinatology, 2003; 30:701–733.
Bernstein P S, Stern R. Beta human chorionic gonadotropin in cervicovaginal secretions as a predictor of preterm delivery. Am J Obstet Gynaecol. 1998 Oct, 179: 870-3.
Sanchez-Ramos L, Mentel C. Human chorionic gonadotropin in cervicovaginal secretions as a predictor of preterm delivery. Int J Gynaecol Obstet. 2003; 83: 151-7.
Kaliprasad Adhikan. Cervicovaginal HCG and Cervical length for prediction of preterm delivery in asymptomatic women at high risk for preterm delivery. Archives of Gynaecology and Obstetrics, 2009: 565-572.
Sogra Khanil, Khalilian Ah Reza. Cervicovaginal beta human chorionic gonadotropin as a marker for prediction of preterm delivery. Evidenced based Midwifery. The Royal College of Midwives. Available from: http//www.rcn.org.uk/learning 2009. Accessed on 30/12/2016.
Georgiou Harry M, Megan Di Quinzio K W, Micheal Perezel and Brennecke Shan P. Predicting Preterm Labour: Current Status and Future Prospects. Disease Markers, Vol 2015 Article ID 435014, 9 pages. Published online 2015.
Norwitz E. R., Robinson J. N. A systematic approach to the management of preterm labour. Seminars in Perinatology, 2001 ; 25 :223-235.
Berghella V., Baxter J.K., Hendrix N. W. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Data base of Systematic Reviews 2013; ICD007235 .
Peng Ren, Shuxia Yao, Jingxvanli Pedro A., Valdes-Sosa, Keith M. Kendrick. Improved
Iams J.D, Romero R. Primary, secondary and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet 2008; 371:164.
Norwitz Errol R, Lockwood Charles J, Varessa Barss A. Prevention of spontaneous preterm birth. Available online; http://www. Update.com/ contents, 2014. Topic 6780 version :330 .Release: 22.10-c22. 245. Accessed ( April 2015).
Muglia L J and Katz M. The enigma of spontaneous preterm birth. The N Engl J of Med,2010; 362:529-535.
Smith V, Devane D, Begley C M , Clake M, and Higgins S. A systematic review of randomized controlled trials of interventions for preventing and treating preterm birth. European Journal of Obstetrics and Gynaecology and Reproductive Biology ,2009; 142:3- 11.
Bernal A L. The regulation of uterine relaxation . Seminars in cell and developmental biology, 2007;18:340-347.
Anototayanonth S, Subheder N V, P. Garner P, Nelson J P, and Hangopal S. Betamimetics for inhibiting preterm labour. Cochrane Database of Systematic Review no.4, article CD004352, 2004.
Crowther C A, Hiller J E, and Doyle L W. Magnesium sulphate for preventing preterm birth in threatened preterm labour. Cochrane Database of systematic review no 4, article CD 001060, 2002.
Mittendoff R and Pryde P G. A review of the role for magnesium sulphate in preterm labour, BJOG. An International Journal of Obstetrics and Gynaecology, 2005; 112:84-88.
Reeves S A, Gibbs R S and Clark S L. Magnesium for fetal neuro protection. AJOG 2011;204:202e1-202e4.
Papatsoris D , Flenady V, Cole S, and Liley H. Oxytocin receptor antagonists for Inhibiting preterm labour .Cochrane Database of systematic Reviews, no.3 article CD004452, 2005.
Wex J, Connolly M, and Rath W. Atosiban versus betamimetics in the treatment of preterm labour in Germany; an economic evaluation, BMC pregnancy and childbirth, 2009; 9: 23.
Simhan H N and Caritis S N. Prevention of preterm delivery. The N Engl J of Med, 2007;357:477-487.
Van Geijn H P, Lenglet J E, and Bolte A C. Nifedipine trials: effectiveness and safety Aspects. British Journal of Obstetrics and Gynaecology, 2005;112:79-83.
Conde-Agudelo A, Romero R, and Kusanovic J P. Nifedipine in the management of preterm labour : a systematic review and meta analysis. AJOG 2011; 204:134e1- 134e20.
Grobman W A, Thom E A . 17 alpha –hydroxyl progesterone caproate to prevent prematurity in nulliparous with cervical length less than 30mm. Am J Obstet. Gynaecol, 2012; 201:390 el.
Rouse D J, Caritus S N . A trial of 17 alpha hydroxyl progesterone caproate to prevent prematurity in twins. N Engl J Med 2007; 357: 454-461.
Norman J E, Mackenzie Owen F. Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomized controlled , double –blind , placebo- controlled study and meta analysis. Lancet 2009; 373:2034-2040.
Berghella V, Rafael T J . Cerclage for short cervix on ultrasonography in women with singleton gestation and previous preterm birth: a meta analysis. Obstet Gynaecol 2011; 117:663-671.
Conde –Agudelo A, Romero R. Vaginal progesterone versus cervical cerclage for the prevention of preterm birth in women with sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison meta analysis. Am J Obstet Gynaecol. 2013; 208:42.el- 42.el8.
Preterm birth: causes, consequences and prevention. Preterm birth, Wikipedia 2014. Available from http://en.m.wikipedia.org/wiki/preterm_birth. (Accessed on March 2017).
Sanij Saigal. An overview of mortality and sequelae of preterm birth from infancy to adulthood. The Lancet 19-25, 2008 ;371:261-269.
Chigbu B, Onwere S, Aluka C. The burden of preterm births in Abia, Southeastern Nigeria. Journal of Medical Investigations and Practice 2014;9:55-58.
Kletzky O A, Rossman F, Bertoli S I, Platt L D, Mishell DR. Dynamics of human chorionic gonadotropin, prolactin and growth hormone in serum and amniotic fluid through out normal human pregnancy. Am J Obstet Gynaecol 1985; 151:878-884.
Hauth JC, Goldenberg L, Andrew WW. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995; 333:1732-6.
Morales WJ, Schorr S, Albrilton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study. Am J Obstet Gynaecol 1994; 171:345-9.
Mc Donald HM, O’Loughlin JA, Vigneswaran R. Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardrenella vaginosis): a randomized placebo controlled trial. Br J Obstet Gynaecol 1997; 104:1391-7.
Ugwumadu A, Manyonda I, Reid F. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomized controlled trial. Lancet 2003; 361:983-8.
Carey JC, Klebanoff MA, Hauth JC. Metronidazole to prevent preterm delivery in. pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med 2000; 342:534-40.
Vermeulen GM, Bruinse HW. Prophylactic administration of Clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: a randomized placebo-controlled double-blind trial. Br J Obstet Gynaecol 1999; 106:652-7.
Ibharesebhor SE, Afadapa MA. Epidermiology of preterm delivery in Benin City. Nig J Paediatrics 1996;23:27-32.
Massome Rezaei, Shole Shahgheibi, Roonak Shahoei, Farnaz Zadvakili, Fariba Farhadifar, Narjes Noori, Fariba Saiedalshoiadaei. Cervicovaginal biomarkers and C-reactive protein levels in preterm and term labour. Life Science Journal 2013;10(6s).
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