Study Of Phosphorylated Isoforms Of IGFBP-1 In Cervical Secretion,Cervical Bishop Score And Ultrasonographic Cervical Index In Prediction Of Labor

Objective To study the efficacy of phosphorylated isoforms of insulin-like growth factor binding protein-1 (IGFBP-1) in cervical secretion, cervical Bishop Score and cervical index in prediction of labor.Methods Testing phosphorylated IGFBP-1 in cervical secretion, cervical Bishop Score, and trans-perineal sonography was performed in 49 pregnant women,with intact membranes and without prenatal hemorrhage and other complications. Successive measurement of phosphorylated IGFBP-1 in cervical secretion and cervical Bishop score was carried out since 38 weeks of gestation. Cervical parameters of the trans-perineal sonography were evaluated including endocervical length, the presence of funneling, funnel length and cervical index[(Funnel length+l)/Endocervical length] in the meantime since 38 weeks of gestation and the time of labor was written down.Results CD Of 113 phosphorylated IGFBP-1 tests done in 49 subjects, positive results were found in 16 tests, weak positive results in 33 tests and negative results in 64 tests. In positive subjects, 14 tests natural delivery was expected within 72h; in weak positive subjects, 6 tests natural delivery was expected within 72h, 21 tests within one week, 6 tests were not natural delivery within one week; in negative subjects, 6 tests natural delivery within one week, 58 tests were not natural deliverywithin one week. The comparison of natural delivery within 72h among the positive,weak positive and negative test has markedly difference (x2=70.14 ,p<0.01).?In positive subjects average cervical Bishop Score was (8.75 + 0.86), weak positive subjects average cervical Bishop Score was(5.97+1.10). The comparison of two has markedly difference(P<0.01). Negative subjects average cervical Bishop Score was(4.95+1.01) ,the comparison of the cervical Bishop Score between weak positive and negative has markedly difference (P<0.01).(3) In positive subjects, average cervical index was 0.62 + 0.13, weak positive 0.37±0.09, the comparison of the two has markedly difference (pO.Ol). In negative subjects average cervical index was 0.33 + 0.03, The comparison of the two has markedly difference (pO.Ol).(4) The starting time of labour has linear correlation with cervical Bishop score( y=l62.02-18.56x,P<0.01).?Sensitivity , specificity, positive and negative predictive values of the rapid positive phIGFBP-1 test for natural delivery within 72h were77.78%, 97.89%> 87.5%, 95.87% respectively. Sensitivity , specificity, positive and negative predictive values of the rapid negative phIGFBP-1 test for non-delivery within one week were 90.63%, 87.76% , 90.63%, 87.76% respectively. Sensitivity , specificity, positive and negative predictive values of the rapid weak positive phIGFBP-1 test for natural delivery within 72h were30%, 70.97%, 18.18%, 82.5% respectively. Sensitivity , specificity, positive and negative predictive values of the rapid weak positive phIGFBP-1 test for non-delivery within one week were 9.38%, 44.89%, 18.18%, 27.5% respectively.In weak positive receiver operating characteristic curve analysis showed that a cervical index of 0.40 was the best cut off point to predict the starting time of labor within 72h. The sensitivity , specificity were83.3% 96.3% respectively.A cervical index of 0.33 was the best cut off point to predict nondelivery within one week. The sensitivity , specificity were81.5%, 87.6% respectively.Receiver operating characteristic curve analysis showed that a cervical Bishop score of 7.5 was the best cut off point to predict the starting time of labor within 72h. The sensitivity , specificity were83.3% 85.2 % respectively.A cervical Bishop score of J.5 was the best cut off point to predict non- delivery within one week. The sensitivity specificity 77.8% 86.7% respectively.Conclusion Positive IGFBP-1 can predict the starting time within 72h alone.Negative IGFBP-1 can predict non- delivery within one week alone.But the capacity of weak positive IGFBP-lto predict the starting time is not satisfied.In weak positive a cervical index of 0.40 and Bishop score of 7.5 were the best cut off point to predict the starting time of labor within 72h,and a cervical index of 0.33 and cervical Bishop score of T.5 were the best cut off point to predict non- delivery within one week.These methods are rapid, convenient, atraumatic and effective.