الفهرس 
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Abstract
Preterm birth, defined as birth occurring before 37 weeks of gestation, is a common complication of pregnancy and may lead to death or long-term disability in newborns (Goldenberg et al., 2008). In a pregnant woman with infection, increases cytokines levels in blood which leads to the production of prostaglandin and ultimately cause to induce uterine contractions and dilation of cervix and preterm delivery (Mueller-Heubach et al., 1990). To find a prediction model for the progression of preterm labor to preterm delivery, many studies focused on the analysis of biochemical markers in blood such as CRP and ALKP (Dörtbudak et al., 2005).
Although several drugs and other interventions have been used to prevent or inhibit preterm labor, non has been shown to be completely effective, Tocolytic agents do not markedly prolong gestation but may delay delivery in some women for up to 48 hours (American College of Obstetricians and Gynecologists, 2013). The role of tocolytic agents (Simhan and Caritis, 2016) is to prolong the time to delivery so that antenatal corticosteroids can be administered, and the mother can be transferred to a tertiary care facility with a neonatal intensive care unit The aim of our work was to study the role of CRP, AlkP and cervical length in prediction of preterm Delivery and response to tocolytic therapy.
In this study, we started with 240 women with singleton pregnancies between 20 to 37 weeks of gestation were included, 12 women were excluded as they were lost during our research, we continued with 228 women. The study population included two groups:
- group 1 (study group) included 114 pregnant women with the diagnoses of new- onset preterm labour that is defined as more than four uterine contractions per hour with regular frequent interval and cervical changes (Roman, 2013).
- group 2 (control group) included 114 pregnant healthy women without maternal or fetal complications during routine antenatal visit.
In this study US cervical length in (mm) was significantly lower in patient group than that controls, while CRP&ALKP were higher in patient group than controls .
Us Cervical length at cut off point 16mm or less was predictable of preterm labor before 48h by94.3.% sensitivity, 87.5% specificity, 99.% PPV, 53.8% NPV & 93.9% accuracy .
Maternal serum ALkP at cutoff point 265.5 or more was predictable of preterm labor by 63.2% sensitivity, 69.3% specificity, 67.3% PPV, 65.3% NPV & 66.2% accuracy. ALkP at cutoff point less than 395 was predictable for respose of tocolytics by 75.0% sensitivity, 70.8.5% specificity, 16.2.1% PPV, 97.4% NPV & 71.1% accuracy.
CRP at cutoff point 7.5 or more was predictable of preterm labor by 71.1% sensitivity, 64% specificity, 66.4% PPV, 68.9% NPV & 67.5% accuracy.
. CRP at cut off point less than 19 was predictable for response to tocolytics by 87.5% sensitivity, 67.9% specificity, 17.1% PPV, 98.6% NPV & 69.3% accuracy.
Our results showed that US cervical length, maternal serum CRP and ALP were risk factors for preterm labor. Cervical length ≤ 16mm increased risk of preterm labor before 48hs by approximately 8 folds (OR=6.25). Maternal serum CRP ≥ 19was increased risk of non-responders by approximately 4 folds (OR=3.75). Maternal serum ALP ≥ 395was increased risk of non-responders by approximately 3 folds (OR=2.45).
In our study, CRP and ALK-P level and cervical length on prediction of preterm birth demonstrated a significant relationship.