Increased level of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery.
OBJECTIVE
The objective of this study was to explore whether increased levels of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery before 34 weeks of gestation in the patient with preterm labor.


METHODS
One hundred and sixty-one women with preterm labor at 22-28 weeks of gestation were enrolled prospectively. The level of granulocyte elastase in cervical secretions was measured by immunoassay, vaginal secretions were collected for the microscopic evaluation of Gram-stained smears, and the uterine cervix was assessed by transvaginal ultrasonography.


RESULTS
Nineteen of 161 patients (12%) delivered before 34 weeks of gestation. Granulocyte elastase assessment had a sensitivity, specificity, positive predictive value, and negative predictive value for preterm delivery of 53, 75, 22 and 92%, respectively. A positive elastase assessment was associated with a relative risk for preterm delivery of 2.9 (95% CI 1.3-6.6), whereas a positive bacterial vaginosis assessment and shorter cervical length less than 25 mm demonstrated a relative risk of 1.9 (95% CI 0.8-4.6) and 1.5 (95% CI 0.6-5.0), respectively.


CONCLUSIONS
The present study demonstrates that the risk of spontaneous preterm delivery before 34 weeks of gestation is increased in the women with preterm labor who are found to have an increased level of granulocyte elastase in cervical secretions.
Nakai
Akihito
A
Tama Nagayama Hospital, Department of Obstetrics and Gynecology, Nippon Medical School, 1-7-1 Nagayama, Tama-City, Tokyo, Japan. nakai-3@nms.ac.jp
Taniuchi
Yoshinari
Y
Miyake
Hidehiko
H
Nakai
Masako
M
Yokota
Akishige
A
Takeshita
Toshiyuki
T
D000328:Adult; D002582:Cervix Mucus / Q000201:enzymology*; D002584:Cervix Uteri / Q000201:enzymology* / Q000378:metabolism; D005260:Female; D006801:Humans; D019272:Leukocyte Elastase / Q000378:metabolism*; D007752:Obstetric Labor, Premature / Q000201:enzymology* / Q000473:pathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016585:Vaginosis, Bacterial / Q000201:enzymology / Q000473:pathology
D019272:Leukocyte Elastase