Contribution to optimising the use of two promising preterm labour screening markers

Scriptie/masterproef: Doctoral Thesis

Uittreksel

Prematurity is a serious medical and socio-economic burden for the
community. Every effort to improve its consequences is worthwhile. Preterm
delivery is considered as a syndrome that can use different pathways. These
allow different approaches for risk screening. In this work, we have studied
the clinical value of 2 promising markers of preterm delivery.
The first marker studied is based on the early separation of the chorion from
the decidua. This is observed when preterm contractions occur, with release
of a glycoprotein, called foetal fibronectin (fFn), in the cervico–vaginal
secretions. The place of the test based on its dosage in our clinical arsenal
remains unclear. We demonstrate here that, to be interpretable, the test
should never be done on cervical samples, and never within the 24 h
following coitus. Furthermore, considering likelihood ratios as the best
objective parameters to evaluate the performance of a test, our two metaanalyses
clearly showed that this test was disappointing as a screening
method as well as a diagnostic tool whatever the clinical settings considered.
The second marker studied concerns Ureaplasma spp., which is involved as
pathogenic agent leading to preterm delivery. Thanks to two prospective
studies, we have been able to demonstrate that carriage of U. spp. is
constant during pregnancy and that it is present at a significantly higher
level (both qualitatively and quantitatively) in vaginal secretions than in
those from the cervix. We have also pointed out that bacterial vaginosis is
more often associated with U. urealyticum than with U. parvum, indicating a
greater potential deleterious effect from the first. This thesis provides new
important information for the understanding of parts of the preterm delivery
process and should be a step toward other clinical studies.
Datum Prijs6 jun 2017
TaalEnglish
Toekennende instantie
  • Vrije Universiteit Brussel
BegeleiderLeonardo Gucciardo (Promotor), Walter Foulon (Co-promotor), Filip Cools (Jury), Ingrid Wybo (Jury), Denis Pierard (Jury), Giancarlo Di Renzo (Jury) & Roland Devlieger (Jury)

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