[Predictive value of cervical-vaginal prolactin in the evaluation of premature labor risk].
OBJECTIVE
To determine whether the presence of cervico-vaginal prolactin during pregnancy is significantly associated with preterm delivery.


METHODS
A cohort of 64 pregnant women between 21 and 34 weeks of amenorrhea underwent a washing of the exocervix and vaginal fornices with a normal saline solution. The fluid was then aspirated and centrifuged. Samples were stored at -70 degrees C and later prolactin level was determined by radioimmunoassay. Test was considered as positive for a prolactin concentration higher than 2 ng/ml. Statistical analysis were realized by Student's t test, Fisher's exact test and chi 2 test.


RESULTS
In patients with preterm labor, positive cervico-vaginal prolactin had a positive predictive value of 36% and a negative predictive value of 94% for a preterm delivery before 34 weeks of gestation (respectively 45% and 79% before 37 weeks). The sensitivity of a positive test was 31% for preterm delivery before 37 weeks of gestation and specificity was 87% (respectively 57% and 88% before 34 weeks). Patients with a positive prolactin test had a significantly shorter latency between testing and delivery (33.7 days vs 52.4 days; p < 10(-9)). No delivery occurred during the following weeks for patients with a negative prolactin test and, among those, only one delivery occurred during the second week following the test. Positive prolactin tests correlated with a mean cervical dilatation of 1 centimetre at the time of testing, while it was of 0.6 centimetre for patients with a negative prolactin test.


CONCLUSIONS
Cervico-vaginal prolactin seems to be a non convincing marker for preterm delivery but indicative of a shorter latency from testing to delivery in symptomatic patients. Further investigations are necessary to evaluate accuracy of cervico-vaginal prolactin as a biochemical marker for imminent delivery in patients with preterm labor.
Jotterand
A D
AD
Service de Gynécologie-Obstétrique, Hôpital Robert-Ballanger, Aulnay-sous-Bois.
Caubel
P
P
Guillaumin
D
D
Augereau
F
F
Chitrit
Y
Y
Boulanger
M C
MC
D000328:Adult; D015415:Biomarkers; D002584:Cervix Uteri / Q000737:chemistry*; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000175:diagnosis*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011388:Prolactin / Q000032:analysis*; D011863:Radioimmunoassay; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D007507:Therapeutic Irrigation; D014621:Vagina / Q000737:chemistry*
D015415:Biomarkers; D011388:Prolactin
Valeur prédictive de la prolactine cervico-vaginale dans l'évaluation du risque d'accouchement prématuré.