A randomized clinical trial of Premaquick biomarkers versus transvaginal cervical length for pre-induction cervical assessment at term among pregnant women

Abstract

Objectives: To compare Premaquick biomarkers (combined insulin-like growth-factor binding protein 1 and interleukin-6) and cervical length measurement via transvaginal ultrasound for pre-induction cervical evaluation at term among pregnant women. Methods: A randomized clinical trial of consenting pregnant women at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The women were randomized equally into Premaquick group ( n = 36) and transvaginal ultrasound group ( n = 36). The cervix was adjudged ‘ripe’ if the Premaquick test was positive or if the trans-vaginal measured cervical length was less than 28 mm. The primary outcome measures were the proportions of women who needed prostaglandin analogue for cervical ripening and the proportion that achieved vaginal delivery after induction of labour. The trial was registered in Pan African clinical trial registry (PACTR) registry with approval number PACTR202001579275333. Results: The baseline characteristics were similar between the two groups ( p > 0.05). There was no statistically significant difference between the two groups in terms of proportion of women that required prostaglandins for pre-induction cervical ripening (41.7 versus 47.2%, p = 0.427), vaginal delivery (77.8 versus 80.6%, p = 0.783), mean induction to delivery interval (22.9 ± 2.81 h versus 24.04 ± 3.20 h, p = 0.211), caesarean delivery (22.2 versus 19.4%, p = 0.783), proportion of neonate with birth asphyxia (8.30 versus 8.30%, p = 1.00) and proportion of neonate admitted into special care baby unit (16.7 versus 13.9%, p = 0.872). Subgroup analysis of participants with ‘ripe’ cervix at initial pre-induction assessment showed that the mean induction to active phase of labour interval and mean induction to delivery interval were significantly shorter in Premaquick than transvaginal ultrasound group. Conclusion: Pre-induction cervical assessment at term with either Premaquick biomarkers or transvaginal ultrasound for cervical length is effective, objective and safe with similar and comparable outcome. However, when compared with women with positive transvaginal ultrasound at initial assessment, women with positive Premaquick test at initial assessment showed a significantly shorter duration of onset of active phase of labour and delivery of baby following induction of labour.

Neutrophil Elastase as a Predictor of Delivery in Pregnant Women with Preterm Labour

“…Evidence has revealed that the incidence of preterm labor is globally rising. [1][2][3][4][5][6][7] This can be more keenly felt in this environment due to the lack of sophisticated equipment and technology for enhancing the survival of preterm babies. Therefore, there is a need to stem this tide.…”

“…[1][2][3][4] This represents approximately 10% of all births and is responsible for 75% of perinatal mortality and 50% of long-term morbidity. 5,6 Preterm labor can lead to preterm birth. Preterm birth continues to be the principal reason for global perinatal near-misses and mortality.…”

Obstetric Outcome of Induction of Labour in a Tertiary Hospital in Nigeria: A Five-Year Retrospective Cross-Sectional Study

“…Induction when successful results in vaginal delivery. Though, it is not free of adverse outcome, IOL is an efficient and safe method of vaginal delivery [ 9 ] . It can sometimes be complicated with potential fetal and maternal risks such as increased rate of abdominal delivery, excessive uterine activity, fetal heart rate abnormalities, uterine rupture, birth asphyxia, intrauterine fetal death (IUFD), maternal water intoxication, preterm delivery due to erroneous estimation of gestational dates, and possible cord prolapse [ 5 , 7 , 10 ]…”