The Preterm Prediction Study: Failure of midtrimester cervical sialidase level elevation to predict subsequent spontaneous preterm birth

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Abstract

OBJECTIVE

Our objective was to determine any associations among midtrimester cervical fluid sialidase activity, bacterial vaginosis, and subsequent spontaneous preterm birth.

STUDY DESIGN

In this nested case-control study all patients (n = 126) with spontaneous preterm birth at <35 weeks' gestation and selected control subjects delivered at >or=to37 weeks' gestation (n = 126, matched for race, parity, and center) were derived from women enrolled in the multicenter National Institute of Child Health and Human Development Preterm Prediction Study. Sialidase activity and presence of bacterial vaginosis according to Gram stain were determined in cervical swabs and vaginal smears, respectively, obtained at 22 weeks' to 24 weeks 6 days' gestation.

RESULTS

The mean +/- SD sialidase activities were similar in case patients and control subjects (0.64 +/- 1.60 vs 0.41 +/- 0.94 nmol [middle dot] mL-1 [middle dot] min-1, P = .21). Neither sialidase activity above the 90th percentile (10.3% vs 9.5%, P = .8) nor sialidase activity above the 95th percentile (7.9% vs 4.8%, P = .3) of control specimens (>1.43 and >2.23 nmol [middle dot] mL-1 [middle dot] min-1, respectively) was associated with spontaneous preterm birth. The frequency of combinations of bacterial vaginosis and elevated sialidase activity was similar (P >or=to .63 with either cutoff) in case patients and control subjects. Sialidase activity was significantly higher among women with bacterial vaginosis than among those without bacterial vaginosis (1.35 +/- 1.87 vs 0.03 +/- 0.14 nmol [middle dot] mL-1 [middle dot] min-1, P < .0001).

CONCLUSIONS

Elevated cervical fluid sialidase activity at 22 to 24 weeks' gestation did not distinguish women at increased risk for spontaneous preterm birth, nor did it discriminate a subgroup of patients who had bacterial vaginosis associated with spontaneous preterm birth. (Am J Obstet Gynecol 1999;180:1151-4.)

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