To determine the utility of measuring phospholipase A2 (PLA2), phospholipase C (PLC), and lipase activity levels in cervicovaginal secretions to predict spontaneous preterm delivery.
This is a prospective cohort study involving 229 pregnant women attending our center for prenatal care. Cervicovaginal samples were first collected between 18-22 weeks and subsequently, between 26-32 weeks. The samples were assayed for PLA2, PLC and lipase activity. Logistic regression analysis was used to determine whether such enzyme activity is an independent predictor for spontaneous preterm delivery or PPROM after controlling for a history of preterm delivery, vaginal bleeding, insurance status, parity and race.
Of 229 women, 35 (15%) delivered prior to 37 weeks′ gestation. Of the preterm deliveries, 17 (49%) was complicated by PPROM. Univariate analysis revealed that a history of preterm delivery, multiparity and lack of health insurance was significantly more common in the preterm delivery group. Lipase enzymatic activity determined at 26-32 weeks was an independent predictor of spontaneous preterm birth (p=0.038). However, PLA2 and PLC failed to predict preterm birth. PPROM could not be predicted by any of the biomarkers studied. The change in enzymatic activity between the second and third trimester samples also failed to predict spontaneous preterm birth or PPROM.
Lipase or lipase-producing bacteria in the lower genital tract may play a role in the pathogenesis of spontaneous preterm birth.
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.