{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:48:07Z","timestamp":1791888487884,"version":"4.3.4"},"reference-count":97,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,9,4]],"date-time":"2018-09-04T00:00:00Z","timestamp":1536019200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the accuracy of placental alpha microglobulin\u20101 (PAMG\u20101), fetal fibronectin (fFN) and phosphorylated insulin\u2010like growth factor\u2010binding protein\u20101 (phIGFBP\u20101) tests in predicting spontaneous preterm birth (sPTB) within 7\u2009days of testing in women with symptoms of preterm labor, through a systematic review and meta\u2010analysis of the literature. The test performance of each biomarker was also assessed according to pretest probability of sPTB \u2264\u20097\u2009days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Cochrane, MEDLINE, PubMed and ResearchGate bibliographic databases were searched from inception until October 2017. Cohort studies that reported on the predictive accuracy of PAMG\u20101, fFN and phIGFBP\u20101 for the prediction of sPTB within 7\u2009days of testing in women with symptoms of preterm labor were included. Summary receiver\u2013operating characteristics (ROC) curves and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive (LR+) and negative (LR\u2013) likelihood ratios were generated using indirect methods for the calculation of pooled effect sizes with a bivariate linear mixed model for the logit of sensitivity and specificity, with each diagnostic test as a covariate, as described by the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Bivariate mixed model pooled sensitivity of PAMG\u20101, fFN and phIGFBP\u20101 for the prediction of sPTB \u2264\u20097\u2009days was 76% (95% CI, 57\u201389%), 58% (95% CI, 47\u201368%) and 93% (95% CI, 88\u201396%), respectively; pooled specificity was 97% (95% CI, 95\u201398%), 84% (95% CI, 81\u201387%) and 76% (95% CI, 70\u201380%) respectively; pooled PPV was 76.3% (95% CI, 69\u201384%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05), 34.1% (95% CI, 29\u201339%) and 35.2% (95% CI, 31\u201340%), respectively; pooled NPV was 96.6% (95% CI, 94\u201399%), 93.3% (95% CI, 92\u201395%) and 98.7% (95% CI, 98\u201399%), respectively; pooled LR+ was 22.51 (95% CI, 15.09\u201333.60) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05), 3.63 (95% CI, 2.93\u20134.50) and 3.80 (95% CI, 3.11\u20134.66), respectively; and pooled LR\u2013 was 0.24 (95% CI, 0.12\u20130.48) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05), 0.50 (95% CI, 0.39\u20130.64) and 0.09 (95% CI, 0.05\u20130.16), respectively. The areas under the ROC curves for PAMG\u20101, fFN and phIGFBP\u20101 for sPTB \u2264\u20097\u2009days were 0.961, 0.874 and 0.801, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the prediction of sPTB within 7 days of testing in women with signs and symptoms of preterm labor, the PPV of PAMG\u20101 was significantly higher than that of phIGFBP\u20101 or fFN. Other diagnostic accuracy measures did not differ between the three biomarker tests. As prevalence affects the predictive performance of a diagnostic test, use of a highly specific assay for a lower\u2010prevalence syndrome such as sPTB may optimize management. Copyright \u00a9 2018 ISUOG. 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