Correlação entre marcadores bioquímicos e medida ultrassonográfica do comprimento do colo uterino na predição do trabalho de parto pré-termo

Abstract

Objective: To evaluate the measurement of uterine cervix and maternal serum levels of total cholesterol and fractions, triglycerides and asymmetric arginine di-methyl (ADMA), isolated or in association, as predictors of preterm delivery. Methods: This longitudinal, prospective study of correlation among variables and gestational age at birth (<or>=37 weeks) was previously approved by the local Ethics Committee (CAAE:51489715.6.0000.5149). Between 2015 to 2016, 145 pregnant women with risk factors for preterm labor, from 20 to 24 weeks' gestation, were evaluated through the ultrasound measurement of the cervix and serum levels of the biomarkers. Pregnant women younger than 18 years, those who used progesterone as prevention of a possible preterm delivery and cases of therapeutic prematurity were excluded. A correlation analysis was performed among the biomarkers and the cervix measurement by the Spearman correlation test. The ROC Curve was used to determine the accuracy of the variables. Sensitivity and specificity were calculated for the variable that was considered predictive for preterm delivery, with different cut-off points. Statistical analysis was carried employing the SPSS 20.0 and a value of P<0.05 was considered statistically significant. Results: Considering the significance level of 5%, the cervix length show an area under the ROC curve of 0.698 (CI 0.540;0.856). Total cholesterol, HDL, non-HDL, triglycerides and ADMA presented low values of the area under the ROC curve. No significant correlation between these biomarkers and the outcome evaluated (preterm labor) was observed. Conclusion: Only the uterine cervix below 2.5cm, measured by ultrasound, between 20-24 weeks gestation was associated with the occurrence of preterm birth in pregnant women at risk, with specificity of 98%.