Scale for Assessing Risk of Extremely Preterm Birth
Study Objective: To improve the outcomes of preterm birth (PB) by using a scale to assess the risk of extremely PB in pregnant women at risk of PB. Study Design: This was a retrospective study. Materials and Methods: The authors analyzed 194 pregnancy assessment forms and labor and delivery charts of women who were admitted to a the maternity department of N. E. Bauman Moscow City Clinical Hospital between week 22 and 27 (+ 6 days) of gestation with regular contractions and cervical shortening of less than 25 mm. Of them, 105 women gave birth before week 28, and 89 women gave birth after week 28. Study Results: Risk factors of extremely PB included age of > 35; body mass index of > 30 kg/m2; being unmarried; a low educational level (lack of professional education); a lack of regular follow-up during pregnancy; pregestational hypertension; uterine leiomyoma; oligohydramnios; and anemia during pregnancy. A total score of 7 or greater, as measured by the scale for assessing the risk of extremely PB, means a pregnant woman is at high risk of extremely PB. The sensitivity and specificity of this assessment was 92.4% and 89.4%, respectively, and its positive predictive value and negative predictive value were 94.6% and 85.5%, respectively. Conclusion: Risk assessment of extremely PB should be done in all women who have cervical shortening of < 25 mm at weeks 22-28 of gestation. The proposed scale is an optimal technical tool for groups at risk. Those with a total score of 7 or greater, as measured by the scale for assessing the risk of extremely PB, should be immediately given tocolytic agents and preventive treatment for infant respiratory distress syndrome and taken to a tertiary inpatient facility.