title: Increased level of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery.
abstract: 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.
authors.affiliation: Tama Nagayama Hospital, Department of Obstetrics and Gynecology, Nippon Medical School, 1-7-1 Nagayama, Tama-City, Tokyo, Japan. nakai-3@nms.ac.jp
authors.forename: Akihito
authors.initials: A
authors.lastname: Nakai
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Taniuchi
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Miyake
authors.forename: Masako
authors.initials: M
authors.lastname: Nakai
authors.forename: Akishige
authors.initials: A
authors.lastname: Yokota
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takeshita
mesh_terms: 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
chemical_list: D019272:Leukocyte Elastase