title: Raised electrical uterine activity and shortened cervical length could predict preterm delivery in a low-risk population.
abstract: OBJECTIVE
  To compare diagnostic accuracy of sonographic cervical length (CL) measurement and uterine electric activity assessed by electromyography (EMG) in second trimester regarding prediction of preterm delivery (PTD).
  
  
  METHODS
  Prospective study of 308 low-risk women. Shortened CL was defined as ≤25 mm (≤5th centile), while raised EMG activity was defined as the presence of ≥20 action potentials in 20 min of assessment (≥95th centile). Outcome measures were diagnostic accuracy of both tests alone or in combination for prediction of PTD and early PTD (≤34 weeks).
  
  
  RESULTS
  The incidence of PTD was 23/308 (7.4%) while the incidence of early PTD was 9/308 (2.9%). Shortened CL and raised EMG activity were significantly related to PTD [prevalence-weighted likelihood ratio (pw-LR) 1.9, 95% CI 1.0-3.5 vs. 9.5, 95% CI 2.5-35.7], but not to early PTD (pw-LR 0.4, 95% CI 0.2-0.8 vs. 0.6, 95% CI 0.3-1.7). Significant predictive value for early PTD was found only if both tests were combined (pw-LR 4, 95% CI 1.3-14.3).
  
  
  CONCLUSIONS
  Shortened CL and raised EMG activity in second trimester have significant diagnostic accuracy regarding prediction of PTD in a low-risk population. However, in order to be useful as a predictor for early PTD both tests must be positive.
authors.affiliation: University Department of Obstetrics and Gynecology, University Hospital Sestre Milosrdnice, Vinogradska cesta 29, Zagreb, 10000, Croatia. ozren.grgic@gmail.com
authors.forename: Ozren
authors.initials: O
authors.lastname: Grgic
authors.forename: Ratko
authors.initials: R
authors.lastname: Matijevic
authors.forename: Krunoslav
authors.initials: K
authors.lastname: Kuna
mesh_terms: D000200:Action Potentials / Q000502:physiology*; D000328:Adult; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004576:Electromyography; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012680:Sensitivity and Specificity; D055815:Young Adult