title: The Preterm Prediction Study: prediction of preterm premature rupture of membranes through clinical findings and ancillary testing. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
abstract: OBJECTIVE
  Our objective was to determine the relative importance of demographic characteristics, clinical risk factors, and ancillary screening tests in the prediction of preterm birth as a result of premature rupture of membranes.
  
  
  METHODS
  A total of 2929 women were evaluated in 10 centers at 23 to 24 weeks' gestation. Demographic and clinical characteristics were ascertained. Cervicovaginal fetal fibronectin and bacterial vaginosis were evaluated. Cervical length was measured by vaginal ultrasonography. Patients were evaluated for spontaneous preterm birth caused by preterm premature rupture of membranes at <37 and <35 weeks' gestation. Multivariate analyses were performed separately for nulliparous women and multiparous women.
  
  
  RESULTS
  Premature rupture of membranes at <37 weeks' gestation complicated 4.5% of pregnancies, accounting for 32.6% of preterm births. Univariate analysis revealed low body mass index, pulmonary disease, contractions within 2 weeks, short cervix (</=25 mm), positive results of fetal fibronectin screening, bacterial vaginosis, and a previous preterm birth caused by premature rupture of membranes (in multiparous women) to be significantly associated with preterm birth caused by premature rupture of membranes in the current gestation. Short cervix, previous preterm birth caused by premature rupture of membranes in multiparous women, and presence of fetal fibronectin were the strongest predictors for both preterm birth caused by premature rupture of membranes at <37 and <35 weeks' gestation. Women with positive fetal fibronectin screening results and a short cervix had greater risks both of preterm birth caused by premature rupture of membranes at <37 weeks' gestation (relative risk, 4.9) and of preterm birth caused by premature rupture of membranes at <35 weeks' gestation (relative risk, 13.5) than did those without these risk factors. Multiparous women with all three risk factors had a 31. 3-fold increased risk of preterm birth caused by premature rupture of membranes at <35 weeks' gestation.
  
  
  CONCLUSIONS
  The combination of short cervical length, previous preterm birth caused by preterm premature rupture of membranes, and positive fetal fibronectin screening results was highly associated with preterm delivery caused by preterm premature rupture of membranes in the current gestation.
authors.forename: B M
authors.initials: BM
authors.lastname: Mercer
authors.forename: R L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: P J
authors.initials: PJ
authors.lastname: Meis
authors.forename: A H
authors.initials: AH
authors.lastname: Moawad
authors.forename: C
authors.initials: C
authors.lastname: Shellhaas
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.forename: M K
authors.initials: MK
authors.lastname: Menard
authors.forename: S N
authors.initials: SN
authors.lastname: Caritis
authors.forename: G R
authors.initials: GR
authors.lastname: Thurnau
authors.forename: M P
authors.initials: MP
authors.lastname: Dombrowski
authors.forename: M
authors.initials: M
authors.lastname: Miodovnik
authors.forename: J M
authors.initials: JM
authors.lastname: Roberts
authors.forename: D
authors.initials: D
authors.lastname: McNellis
mesh_terms: D002584:Cervix Uteri / Q000737:chemistry / Q000000981:diagnostic imaging; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005333:Fetus / Q000378:metabolism; D005353:Fibronectins / Q000032:analysis; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000209:etiology*; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors; D014463:Ultrasonography; D014621:Vagina / Q000737:chemistry; D016585:Vaginosis, Bacterial / Q000175:diagnosis
chemical_list: D005353:Fibronectins