The place of multiple markers in the detection of preterm delivery

VIII. İNGİLİZCE ÖZETSUMMARYTHE PLACE OF MULTIPLE MARKERS IN THE DETECTION OFPRETERM DELIVERYPreterm birth, as a basic obstetric problem, is described as the birthbefore 37th weeks of gestation. Some patients consulting with pretermlabor symptoms receiving tocolytic drug therapy or no drug therapy do notgive preterm birth. Among the patients attending with preterm labor whichreally will give preterm birth is unknown. Therefore researches are madeto enlighten the patho-physiology and concluded that the etiology ofpreterm birth is multifactorial. Two of the most important factors are acuteinflammation and premature activation of maternal-fetal-hypotalamo-pituitary-adrenal axis (HPA) after placental ischemia.Many biochemical identifiers that may increase in the maternal blooddealing with the preterm birth etiologic factors are investigated. Only onetest may not be adequate for preterm birth diagnosis. In this research, it isaimed to investigate the possibility of the determination of preterm birth byusing cervical measurement, bishop score, CRH, IL-6, ICAM-1 andhomosystein levels in maternal serum.In our study, among the patients attending with preterm laborsymptoms we observed randomly selected 32 pregnant less than 37thweek and 30 pregnant less than 37th week and over 24th week.Contraction is confirmed with either manually or using non stress test atevery pregnant. Cervical dilatation and effacement determined with vajinalexamination. Bishop scoring system is used for scoring and ultrasoundgraph for cervical measurements. In case of the probability of the relationbetween preterm labor activity and infection flux specialty is estimated with51sterile speculum. Specimens are taken for culture tests. IL-6, ICAM-1 andhomosystein are investigated in maternal serum.Patients of the both groups had similar average age, pregnancy weekand body mass index (BMI). Statistically significant difference is observedin Bishop scoring, cervical dilatation, effacement and length (p=0.001).Biochemical data of IL-6 and homosystein were significantly different whileCRH and ICAM-1 levels were not.Infection was detected in 18 (%90) patients out of 20 women of thepreterm risk group who agreed with speculum examination and in 27(%96.43) patşents out of 28 women of the control group. Onmicrobiological examination bacterial vaginosis was detected in 2 (%10)patients out of the preterm risk group, change in vajinal flora in 3 (%15),and normal flora in 15 (%75) patients. In the control group 2 (%7.14)patients had bacterial vaginosis, 4 (%14.28) had change in vajinal floraand 22 (%78.57) had normal flora.Clinical and biochemical markers were compared between patientswho gave birth within one week and who did not. Maternal characterisiticswere similar. Change in servical length was significantly greater in thepatients who gave birth within one week. As biochemical markers IL-6 wassignificantly greater in the patients who gave birth within one week(p=0.034). Homocystein, ICAM-1 and CRH values were similar in bothgroups.In this study Bishop Score and IL-6 were more significant indetermining preterm birth within week than servical length. In determiningpreterm birth after one week servical length was more valuable. ForBishop Score and IL-6 threshold value was found as 4.5 and 39, 5 pg/ml,respectively. The threshold value for servical length was found as 21mm.Keeping in mind the heterogenous ethiology of preterm birth checkingmultipl markers will help us to diagnose preterm birth and to discriminatepseudo preterm birth and thus prevent unnecessary interventions.52