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Background: The aim of this study was to assess the efficacy of PAMG-1 test (placental alpha microglobulin-1) in cervicovaginal secretions collected immediately following transvaginal ultrasound (TVUS) of women with signs and symptoms of preterm labor (PTL), clinically intact membranes and cervical length between 15 and 30 mm for the prediction of imminent spontaneous delivery (within 7 days of testing), as well as delivery <34 weeks of gestation., Methods: Performing PAMG-1 test in 79 women with singleton pregnancy (240/7 -336/7 weeks' gestation) reporting signs and symptoms indicative of PTL and cervical length <30 mm., Results: For PTB prediction risk within 7 days of testing in pregnant women with cervicale length between 15-30 mm sensitivity is 100% and specificity is 94%. Positive predictive value (PPV) is 77% and negative predictive value (NPV) is 100%. For delivery prediction <34 weeks of gestation sensitivity decreased from 100% to 67% and specificity from 94% to 89%, PPV is 55% and NPV 93%., Conclusions: The inaccuracy of traditional methods, including biophysical tests, biochemical markers, or the combination of both, for assessing the risk of spontaneous preterm birth in patients presenting with symptoms of PTL often leads to unnecessary admission and administration of corticosteroids and tocolytics. The PAMG-1 test demonstrated high efficacy in identifying women at risk of imminent PTL within 7 days of testing, despite being performed immediately after TVUS. High NPV can prevent improper admission and unnecessary therapies for mother and fetus.

Objective: The aim of this study was to evaluate the effectiveness of the fetal fibronetcin (fFN) test and ultrasonographic cervical length measurement used alone or in combination with each other in order to further improve the identification of patients in preterm labor., Methods: Prospective multicenter observational study on patients between 24 and 32 weeks of gestation with symptoms of preterm labor (total patients = 132). The endpoint was the delivery at 34 weeks or more. The screening methods used were: the fFN test (group 1), the cervical length measurement by transvaginal ultrasound (group 2) or a combination of both tests (group 3) according to an established protocol. The statistical analysis was performed using the χ2 test using the SPSS software., Results: Group 1: positive fFN test in 25.7% of cases, incidence of preterm birth (<34 weeks) of 18%. Group 2: cervical length <25 mm in 56.2% of cases, incidence of preterm birth (<34 weeks) of 18.5%. The negative predictive value is equivalent to 99.0% for the fFN test and 95.2% for cervicometry; combined use reaches 100%, compared to 54% positive predictive value., Conclusion: The identification of women at high risk of preterm delivery carried out with the fFN test or with transvaginal ultrasound cervicometry is clinically valid. The study also showed that the contextual use of biochemical and biophysical tests reaches a high negative predictive value (100%), making it a very useful method to identify patients truly at risk and to further reduce the incidence of non adequate treatment.

Background: It has been shown by previous studies that the mean fetal heart rate (FHR) decreases from the 11th to the 30th week, afterwards the values remain more stable. In the present study we evaluated the FHR pattern throughout the last stages of pregnancy and particularly we estimated the interindividual variability to achieve the maturation of the parasympathetic nervous system in the control of the FHR rythm., Methods: Serial FHR determinations were made from the 28th week until term in 126 physiological pregnancies, submitted to umbilical Doppler velocimetry. The mean FHR was measured on the length of 6 cardiac beats. The FHR patterns of 48 healthy pregnancies, were also analyzed longitudinally., Results: The transversal data, related to the 126 physiological pregnancies, show a further decrease of the FHR during the last stages of pregnancy: from the 28th to 40th week it drops from the average value of 141 bpm to 133 bpm (r = -0.1469). The longitudinal data show that this decrease occurs in 27% of patients between the 30th and the 33rd week and in 73% of patients between the 34th and the 40th week., Conclusions: The conclusion is drawn that the physiological decrease of the mean FHR value occurs for each fetus at different gestational ages due to a different balance between the sympathetic and parasympathetic tone; moreover, we find that the interindividual variability in achieving the full maturation of the parasympathetic nervous system is quite wide.

One hundred physiological pregnant women and 76 pathological pregnant women suffering from gestational diabetes and pregnancy-induced hypertension underwent a cardiotocographic examination during the course of routine diagnostic tests. The interpretation of cardiotocographic printouts was carried out using traditional as well as computerised methods. The outcome of these tests was then related to neonatal outcome and other parameters which contributed to defining the prognosis of pregnancy. Computerised analysis was found to provide a more reliable diagnosis in comparison to traditional methods in identifying those pregnancies with a pathological neonatal outcome. In particular, in the group of physiological pregnancies, computerised interpretation proved more reliable in 87.5% of cases in which neonatal outcome was pathological; on the contrary, traditional interpretations only revealed 37.5% of the same cases. In pathological pregnancies, automatic interpretation was also found to be more reliable in predicting the non-pathological outcomes, whereas traditional methods provided a high incidence of uncertain answers.