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Objective. To provide an overview of current research on risk factors for cerebral palsy (CP) in children born at term and hypothesize how new findings can affect the content of the CP registers worldwide. Design. A systematic search in PubMed for original articles, published from 2000 to 2010, regarding risk factors for CP in children born at term was conducted. Methods. Full text review was made of 266 articles. Main Outcome Measures. Factors from the prenatal, perinatal and neonatal period considered as possible contributors to the causal pathway to CP in children born at term were regarded as risk factors. Results. Sixty-two articles met the criteria for an original report on risk factors for CP in children born at term. Perinatal adverse events, including stroke, were the focus of most publications, followed by genetic studies. Malformations, infections, perinatal adverse events and multiple gestation were risk factors associated with CP. The evidence regarding, for example, thrombophilic factors and non-CNS abnormalities was inconsistent. Conclusions. Information on maternal and neonatal infections, umbilical cord blood gases at birth, mode of delivery and placental status should be collected in a standardized way in CP registers. Information on social factors, such as education level, family income and area of residence, is also of importance. More research is needed to understand the risk factors of CP and specifically how they relate to causal pathways of cerebral palsy. [ABSTRACT FROM AUTHOR]

Objective. To study maternal serum interleukin-17 (IL-17) during normal pregnancy and evaluate the association with preterm delivery. Design. Prospective study. Setting. Aarhus University Hospital, Denmark. Population. Three cohorts: (a) low-risk cohort of 1,069 women who had serum drawn in weeks 12 and 19, (b) subgroup of the low-risk cohort, consisting of 40 women, who had serum drawn at 12, 19, 26, 33 and 39 weeks of gestation and (c) a symptomatic cohort of 93 women admitted with symptoms of preterm delivery at a gestational age of 24+ 0 weeks to 33+ 6 weeks. Methods. Serum IL-17 determined by an in-house developed multiplex sandwich immunoassay. Main outcome measures. Preterm delivery <37+0 weeks gestation. Results. Serum IL-17 did not change during normal pregnancy. At admission to hospital, women with preterm contractions had significantly decreased serum IL-17 as compared with normal pregnancies (median <4 [interquartile ranges, IQR, <4-10 pg/ml] vs. 174 pg/ml [IQR, 92 - 485 pg/ml]); this difference was enhanced and highly significant for women delivering preterm versus term (median <4 [IQR, <4-7.9 pg/ml] vs. median 6.0 [IQR, <4-221 pg/ml]; p-value 0.03). Serum IL-17 was also lower in women with preterm prelabor rupture of membranes. A slightly, but not statistically significant decrease was found in weeks 12 and 19 in low-risk women who subsequently delivered preterm. Conclusion. Maternal serum IL-17 may be involved in preterm delivery. [ABSTRACT FROM AUTHOR]

Objective. To examine associations between first-trimester plasma cytokines and spontaneous preterm delivery (sPTD). Design. A case-control study was nested within the Danish National Birth Cohort, a cohort of women with 101,042 pregnancies from 1997 to 2002 who were recruited during pregnancy and followed prospectively. Sample. Subjects included 107 women delivering singleton infants at 24-29 weeks, 353 at 30-33 weeks, 422 at 34-36 weeks, and 1,372 at ≥37 weeks. Methods. Maternal plasma interleukin (IL)-2, IL-6, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and granulocyte-macrophage colony-stimulating factor (GM-CSF) were measured at a median of eight weeks gestation using multiplex flow cytometry. Adjusted odds ratios (ORs) were obtained using polytomous logistic regression. Main outcome measures. sPTD categorized as: 24-29 weeks, 30-33 weeks, 34-36 weeks, and ≥37 weeks (controls). Results. Elevated TNF-α and GM-CSF were associated with an increased risk of delivery at 34-36 weeks. In underweight women, sPTD <34 weeks was associated with elevated (>75th percentile) IL-6 (OR=5.62, 95% confidence interval (CI): 1.73, 18.26) and TNF-α (OR=3.02, CI: 1.02, 8.91) compared with term delivery. Conversely, among obese women, elevated IL-2 (OR=0.30, CI: 0.11, 0.78) and TNF-α (OR=0.15, CI: 0.05, 0.47) were associated with a reduced risk of delivering at <34 weeks. Cytokines were not related to delivery at <34 weeks in normal-weight and overweight women. Conclusions. These findings suggest that the association between first-trimester plasma cytokine levels and sPTD may depend on pre-pregnancy body mass index. [ABSTRACT FROM AUTHOR]

Objective. To investigate the relation between 19 selected single nucleotide polymorphisms in three cytokine genes, tumor necrosis factor alpha (TNFA), interleukin 1-beta (IL1B) and interleukin 6 (IL6) and preterm birth (<37 weeks' gestation). Design. Case-control association study. Sample. A total of 117 singleton pregnant Danish Caucasian women, including 62 preterm birth cases and 55 controls (birth ≥37 weeks). Methods. Genotyping was performed using TaqMan probes and traditional sequencing. Descriptive statistics were carried out with Fisher's exact test and Wilcoxon rank-sum test. All genetic data were tested for Hardy-Weinberg equilibrium and analyzed using logistic regression, 2×2 proportions or χ2. Haplotypes were estimated for each gene and permutation used for association testing. Results. Women carrying the TNFA -857 C>T rare allele (T) and those homozygous for the IL1B -31 T>C and IL1B -511 C>T rare alleles (C and T) have an increased risk of preterm birth with OR 3.1 (95% CI: 1.0-10.3) and OR 6.4 (95% CI: 1.3-60.5), respectively. Two estimated TNFA haplotypes were associated with preterm birth with OR 3.1 (p=0.037) and OR 2.7 (p=0.045). Conclusion. Polymorphisms in the cytokine genes TNFA and IL1B may increase the risk of preterm birth, possibly by a dysregulation of the immune system in pregnancy. [ABSTRACT FROM AUTHOR]

In a previous study, we found that infants transferred to a neonatal ward after delivery had an almost twofold increased risk of being diagnosed with infantile autism later in childhood in spite of extensive controlling of obstetric risk factors. We therefore decided to investigate other reasons for transfer to a neonatal ward, in particular hyperbilirubinaemia and neurological abnormalities. We conducted a population-based matched case–control study of 473 children with autism and 473 matched controls born from 1990 to 1999 in Denmark. Cases were children reported with a diagnosis of infantile autism in the Danish Psychiatric Central Register. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals [CI] and likelihood ratio tests were used to test for effect modification. We found an almost fourfold risk for infantile autism in infants who had hyperbilirubinaemia after birth (OR 3.7 [95% CI 1.3, 10.5]). In stratified analysis, the association appeared limited to term infants (≥37 weeks gestation). A strong association was also observed between abnormal neurological signs after birth and infantile autism, especially hypertonicity (OR 6.7 [95% CI 1.5, 29.7]). No associations were found between infantile autism and low Apgar scores, acidosis or hypoglycaemia. Our findings suggest that hyperbilirubinaemia and neurological abnormalities in the neonatal period are important factors to consider when studying causes of infantile autism. [ABSTRACT FROM AUTHOR]

Background. Few studies have investigated the relationship between inflammation and spontaneous preterm delivery (sPTD) in women before preterm labour. The authors examine whether mid-pregnancy plasma cytokine levels are associated with sPTD, and whether associations vary by maternal age, body mass index, prior preterm delivery, or gravidity. Methods. This case-control study was nested within the Danish National Birth Cohort, a cohort of women with 101,042 pregnancies from 1997 to 2002. Included in this study are 61 women delivering at 24-29 weeks, 278 delivering at 30-33 weeks, 334 delivering at 34-36 weeks, and 1,125 delivering at ≥37 weeks. Maternal plasma interleukin (IL)-2, IL-6, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and granulocyte-macrophage colony-stimulating factor (GM-CSF) at 25 weeks' gestation were measured using multiplex flow cytometry. Results. For IL-2, TNF-α, and GM-CSF, the proportion of women with levels >75th or >90th percentile did not differ by gestational age at delivery. IFN-γ >90th percentile was associated with an increased risk of delivering at 30-33 weeks (crude odds ratio (cOR): 1.56; 95% confidence interval (CI): 1.07-2.30), while IFN-γ >75th percentile and IL-6 >75th percentile were associated with an increased risk of delivering at 34-36 weeks (cOR: 1.32; 95% CI: 1.01-1.73); estimates changed little after adjusting for confounders. There was no effect-measure modification by maternal factors. Conclusion. Elevated mid-pregnancy plasma IL-2, TNF-α, and GM-CSF did not appear to be associated with an increased risk of sPTD, while elevated IFN-γ and IL-6 levels were weakly associated with moderate and late sPTD. The value of using mid-pregnancy cytokines in predicting spontaneous preterm delivery appears limited. [ABSTRACT FROM AUTHOR]

Objective: A higher risk of meningitis associated with cochlear implants may be explained in part by a generally higher risk of meningitis in children with severe to profound hearing loss. We investigated whether children with hearing loss have an increased risk of meningitis. Study design and setting: A historical cohort study of all children born in Denmark between January 1, 1995, and December 31, 2004, was conducted. The cohort was selected through the Danish Medical Birth Registry, and information on hearing loss and meningitis was obtained from the National Hospital Registry. Results: We identified 39 children with both hearing loss and meningitis. Of these children, five were diagnosed first with hearing loss and later with meningitis. The relative risk of meningitis in the group of children with a hearing loss diagnosis, as compared with the non–hearing loss group, was 5.0 (95% CI, 2.0 to 12.0). Conclusions: The study provides evidence for an association between hearing loss and the development of meningitis. Parents and health care providers of children with hearing loss should be more alert for possible signs and symptoms of meningitis, and vaccination should be considered. [Copyright &y& Elsevier]

Background. No larger population-based study of bacterial vaginosis in pregnancy has previously been available. The objective of this study was to examine risk factors for bacterial vaginosis in pregnancy. Design. From a prospective population-based cohort of 3,596 eligible pregnant women, 2,927 (81.4%) completed the study. Methods. Women were asked to participate in this study at their first prenatal visit at 17 gestational weeks (range 7 + 3–24 + 0). Samples from the genital tract were taken at enrolment. Bacterial vaginosis was determined by Amsel's clinical criteria (3 out of 4: pH > 4.5, homogenous discharge, clue cells, and positive amine test). Data were collected from three questionnaires completed during the second and third trimesters and correlated with the diagnosis of bacterial vaginosis. Crude and adjusted relative risks (reproductive, medical, behavioral, sexual, and sociodemographic factors) were computed.. Results. At enrolment, bacterial vaginosis was diagnosed in 13.7% of Danish pregnant women. Significant risk factors for bacterial vaginosis were: daily coitus (adjusted relative risk 2.09 [1.43–3.04]), being single (1.76 [1.21–2.56]), smoking more than 10 cigarettes daily at conception (1.59 [1.29–1.93]), previous genital infection with Chlamydia trachomatis or Neisseria gonorrhoeae (1.39 [1.07–1.79]), and consuming 2 or more drinks per week (1.33 [1.02–1.74]) after control for confounding factors. Conclusion. In pregnancy, women who have daily coitus, are single, smokers, with a previous sexually transmitted disease, or with high alcohol consumption in pregnancy are at increased risk for bacterial vaginosis. Information on these risk factors may be important when planning preventive and treatment strategies of bacterial vaginosis in pregnancy. [ABSTRACT FROM AUTHOR]

Objective. To examine associations of vaginal Ureaplasma urealyticum (UU) and bacterial vaginosis (BV) with preterm delivery (PTD), small for gestational age (SGA), and low birth weight (LBW). Material and methods. A population-based, prospective cohort study of 2,927 pregnancies. After exclusion of multiples and antibiotic use sample size was 2,662. BV (Amsel's criteria) and UU (culture) were assessed in week 17. Gestational age was determined by last menstrual period, confirmed by ultrasound measurement in 97.5%. SGA infants were calculated from intrauterine fetal growth measurements. Results. There was no increased risk for spontaneous PTD among women with BV only (crude odds ratio 1.0, 95% CI 0.4–2.7), among women with UU only (1.3, 0.8–2.0), nor among women with UU + BV (0.9, 0.4–2.3) compared to women without UU and BV. However, there was a threefold increased risk of a LBW birth in women with UU + BV (3.1, 1.8–5.4), a twofold risk of a LBW birth among women with UU only (1.9, 1.3–2.9), but no increased risk among women with BV only (0.8, 0.3–2.2). Similarly, women with UU + BV had over a twofold increased risk of an SGA birth (2.3, 1.3–4.0), women with UU only had a 70% increase (1.7, 1.1–2.5), whereas a nonsignificant increase was found in women with BV only (1.3, 0.6–2.9). Adjustment by established confounders (smoking, previous PTD, previous LBW, and Escherichia coli ) did not affect risk estimates. Conclusion. This analysis suggests that UU is independently associated with fetal growth and LBW and that BV with UU may enhance the risk of these outcomes. [ABSTRACT FROM AUTHOR]

This structured review discusses the current literature on selected biomarkers and their ability to predict preterm delivery (PTD).Among symptomatic women, the likelihood ratio (LR+) for the prediction of PTD was found to be greater than 10 using amniotic fluid (AF) interleukin-6 (IL-6), AFUreaplasma urealyticum,as well as a multi-marker consisting of cervical IL-6, cervical IL-8, and cervical length (CL). The LR+ was found to be between 5 and 10 for serum C-reactive protein (CRP). An LR+ between 2.5 and 5 was recorded for serum corticotropin-releasing hormone (CRH), cervical fetal fibronectin (fFN), cervical IL-6, serum relaxin, and a multi-marker consisting of fFN and CL. CL and bacterial vaginosis (BV) both predicted PTD in women with preterm labor with an LR+ of less than 2.5.In asymptomatic women, AFU. urealyticumand a multimarker consisting of five individual markers[fFN, CL, serum alpha-fetoprotein (AFP), serum alkaline phosphatase, and serum granulocyte colony-stimulating factor (G-CSF)] predicted PTD with an LR+ greater than 10.The LR+ was between 5 and 10 for serum relaxin and CL. LRs+ recorded for serum alkaline phosphatase, salivary estriol, serum CRH, serum G-CSF, cervical IL-6, AF IL-6, cervical fFN, AFP, and Chlamydia all ranged between 2.5 and 5. Finally, an LR+ below 2.5 has been documented for serum ferritin, serum CRP, BV, and cervical ferritin. [ABSTRACT FROM AUTHOR]

: ObjectiveTo evaluate whether serum relaxin (S-relaxin) can predict spontaneous delivery before 34 weeks of gestation in high risk pregnancies.: DesignA prospective cohort study.: SettingCalculated sample size was reached over a two-year period, during which 9507 women gave birth. Of these, 157 healthy women were eligible for the study as they were admitted with symptoms of delivery before 34 weeks of gestation. Ninety-three women were included. Overall participation rate was 59%.: PopulationHealthy women with singleton pregnancies with symptoms of delivery before 34 weeks of gestation.: MethodsS-relaxin was measured using a standard sandwich ELISA.: Main outcome measuresEnd points were preterm delivery before 34 weeks of gestation and delivery within three days from initiation of symptoms. The best possible prediction of preterm delivery was established using logistic regression for risk factors individually associated with preterm delivery before 34 weeks of gestation. S-relaxin was dichotomised to obtain best possible fit and then entered into the model. The same analyses were done for delivery within three days.: ResultsMedian S-relaxin levels varied significantly in the women with preterm prelabour rupture of membranes (PPROM) (316 pg/mL), contractions (222 pg/mL) or ripe cervices (203 pg/mL) (P < 0.05). S-relaxin above the 80th centile (≥300 pg/mL) was associated with an increased risk of preterm delivery [crude OR = 4.8; (95% CI: 1.9–12)]. Likelihood ratio of a positive test is 2.6 (1.5–4.9) and S-relaxin resulted in a post-test probability of preterm delivery of 0.72, compared with a pre-test probability of 0.49. S-relaxin contributed to the identification of delivery within three days [adj. OR = 11 (95% CI: 1.8–64)].: ConclusionS-relaxin may be a useful predictor in women with symptoms of delivery before 34 weeks of gestation. [Copyright &y& Elsevier]

Background: We studied the association between the C-reactive protein level in the maternal serum early in the second trimester with that in preterm delivery.Methods: The present study is a prospective nested case-control study including 84 singleton, preterm deliveries (cases) and 400 singleton, term deliveries (controls), based at the Odense University Hospital, Denmark. These cases were identified from a cohort of 2846 women, monitored from their first prenatal care visit until their delivery. All the participants were examined at enrollment (median 16.3 weeks of gestation). Conventional statistical methods were used for analyses.Results: We found statistically significant differences in the C-reactive protein levels measured in early pregnancy between the women delivering preterm and those delivering at term. Different statistically significant odds ratios of between 1.7 and 2.0 were calculated, depending on the C-reactive protein level's cut-off value, and ranged from 5.6 mg/l (75th percentile) to 16.4 mg/l (95th percentile). The highest level was achieved at the 85th percentile (7.6 mg/l); odds ratio 2.0 (95%CI, 1.2-3.5).Conclusion: A high C-reactive protein level at the beginning of a pregnancy is associated with a nearly twofold increased risk of preterm delivery; however, the clinical value at this point is still limited. [ABSTRACT FROM AUTHOR]

Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal inflammation typically associated with infection also suggest that an inflammatory response may be an important independent etiologic factor. If a substantial proportion of cerebral palsy is attributable to acute amnionitis infection and/or neonatal sepsis, cerebral palsy should have decreased in the United States after administration of intrapartum antibiotics became widespread in response to publication of public health consensus guidelines for Group B streptococcus in 1996. However, failure to detect declines could have a number of explanations and these explanations illustrate the many public health challenges related to intrauterine infection and cerebral palsy. Given the gaps in our current knowledge about intrauterine infection and cerebral palsy, public health recommendations for timely and specific prevention activities are limited at this time. MRDD Research Reviews 2002;8:39–45. © 2002 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Fetal and neonatal mortality and morbidity rates are strongly associated with gestational age for delivery: the risk for poor outcome increases as gestational age decreases. Attempts to predict preterm delivery (PTD, spontaneous delivery before 37 weeks’ gestation) have been largely unsuccessful, and rates of PTD have not improved in recent decades. More recently, the reported associations between infections in pregnancy and PTD suggest preventive initiatives that could be taken. The overall objective of the current study is to assess whether specific markers of infection (primarily interleukin (IL) 1β, tumour necrosis factor (TNF) α, IL-6, and IL-10) obtained from maternal blood during pregnancy, alone or in combination with other risk factors for PTD, permit identification of women at risk for spontaneous PTD. To achieve this objective, data are obtained from two Danish prospective cohort studies involving serial collection of maternal blood samples, newborn cord blood samples, and relevant confounders and other risk factors for PTD. The first study consists of a completed Danish regional cohort of 3000 pregnant women enrolled in a study of microbiological causes of PTD, upon which a nested case-control study of PTD in 84 cases and 400 controls has been performed. The second study is a nested case-control study of 675 PTD cases (equally divided into three gestational age categories of 24–29 weeks’ gestation, 30–33 weeks’ gestation, and 34–36 weeks’ gestation) and 675 controls drawn from the ongoing Danish National Birth Cohort study of 100 000 pregnant women enrolled during 1997–2001. The second study will provide the opportunity to refine and retest hypotheses from the first study, as well as to explore new hypotheses. Our preliminary work suggests that a single predictive marker effectively accounting for a large proportion of PTD is unlikely to be found. Rather, a search for multiple markers... [ABSTRACT FROM AUTHOR]

Examines Mycoplasma hominis isolates to classify variants of variable adherence associated (vaa) genes by polymerase chain reaction, DNA sequencing and immunoblotting. Mosaic gene structure of vaa gene; Comparison of the gene types; Modular composition of the VAA proteins; Causes of variations.

Objective. To identify pre-, peri- and neonatal risk factors for pervasive developmental disorders (PDD). Methods. We searched the Medline database through March 2011 for relevant case-control and population-based studies on pre-, peri- and neonatal hazards related to PDD, including autism. We identified 85 studies for this review. Data were extracted systematically and organized according to risk factors related to family history, pregnancy, gestational age, delivery, birth milestones and the neonate's condition at birth. Results. During the prenatal period, risk factors for PDD were advanced maternal or paternal ages, being firstborn vs. third or later, maternal prenatal medication use and mother's status as foreign born. During the perinatal and neonatal periods, the risk factors for PDD were preterm birth, breech presentation, planned cesarean section, low Apgar scores, hyperbilirubinemia, birth defect and a birthweight small for gestational age. The influence of maternal pre-eclampsia, diabetes, vomiting, infections and stress during pregnancy requires further study in order to determine risk for PDD. Discussion. Despite evidence for the association of some pre-, peri- and neonatal risk factors associated with PDD, it remains unclear whether these risks are causal or play a secondary role in shaping clinical expression in individuals with genetic vulnerability. A plausible hypothsesis is that improvements in obstetric and neonatal management have led to an increased rate of survivors with pre-existing brain damage. Given the variety of risk factors, we propose that future studies should investigate combinations of multiple factors, rather than focusing on a single factor. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether soluble CD163 (sCD163) and C-reactive protein (CRP) can predict spontaneous preterm delivery in women with symptoms of preterm delivery., Design: Prospective cohort study. Setting Labour ward at a tertiary university hospital., Population: Ninety-three women with symptoms of preterm delivery before 34 weeks of gestation., Methods: sCD163 and CRP were individually examined as predictors of preterm delivery. A model for prediction of preterm delivery was established using exact logistic regression for risk factors individually associated with preterm delivery., Main Outcome Measures: Gestational age at delivery., Results: In women with symptoms of preterm delivery, median sCD163 and CRP levels were significantly higher statistically in women delivering preterm (3.4 mg/L, and 62 nmol/L) compared with the women delivering at term (2.7 mg/L, and <48 nmol/L, Mann-Whitney U test, P < 0.01 and P < 0.001) for sCD163 and CRP, respectively. sCD163 above 5 mg/L was associated with an increased risk of preterm delivery (crude OR = 10, [95% CI 1.3-466], adjusted OR = 27, [0.7-infinity]). CRP above 47 mg/L was associated with an increased risk of preterm delivery (crude OR = 5 [1.8-14], adjusted OR = 5 [1.04-31]). Likelihood ratio of a positive test was 8.6 [2.8-14] and 2.8 [0-6.2] for sCD163 and CRP, respectively. The logistic regression model was able to predict 85% of preterm deliveries with 13% false positive, giving a likelihood ratio of 8 [2.2-13.5]., Conclusion: High levels of sCD163 or CRP are associated with an increased risk of preterm delivery in women with symptoms of delivery. Good prediction of preterm delivery before 34 weeks of gestation was obtained by a combination of preterm prelabour rupture of membranes (PPROM), overweight, relaxin, CRP and sCD163.

Objective: To evaluate whether serum relaxin (S-relaxin) can predict spontaneous delivery before 34 weeks of gestation in high risk pregnancies., Design: A prospective cohort study., Setting: Calculated sample size was reached over a two-year period, during which 9507 women gave birth. Of these, 157 healthy women were eligible for the study as they were admitted with symptoms of delivery before 34 weeks of gestation. Ninety-three women were included. Overall participation rate was 59%., Population: Healthy women with singleton pregnancies with symptoms of delivery before 34 weeks of gestation., Methods: S-relaxin was measured using a standard sandwich ELISA., Main Outcome Measures: End points were preterm delivery before 34 weeks of gestation and delivery within three days from initiation of symptoms. The best possible prediction of preterm delivery was established using logistic regression for risk factors individually associated with preterm delivery before 34 weeks of gestation. S-relaxin was dichotomised to obtain best possible fit and then entered into the model. The same analyses were done for delivery within three days., Results: Median S-relaxin levels varied significantly in the women with preterm prelabour rupture of membranes (PPROM) (316 pg/mL), contractions (222 pg/mL) or ripe cervices (203 pg/mL) (P < 0.05). S-relaxin above the 80th centile (> or = 300 pg/mL) was associated with an increased risk of preterm delivery [crude OR = 4.8; (95% CI: 1.9-12)]. Likelihood ratio of a positive test is 2.6 (1.5-4.9) and S-relaxin resulted in a post-test probability of preterm delivery of 0.72, compared with a pre-test probability of 0.49. S-relaxin contributed to the identification of delivery within three days [adj. OR = 11 (95% CI: 1.8-64)]., Conclusion: S-relaxin may be a useful predictor in women with symptoms of delivery before 34 weeks of gestation.