PT - JOURNAL ARTICLE AU - Abbott, D AU - Chin-Smith, EC AU - Seed, P AU - Chandiramani, M AU - Shennan, AH TI - Cervical-vaginal fluid elafin concentrations and subsequent cervical shortening in women at high risk of spontaneous preterm birth AID - 10.1136/fetalneonatal-2012-301809.14 DP - 2012 Apr 01 TA - Archives of Disease in Childhood - Fetal and Neonatal Edition PG - A5--A5 VI - 97 IP - Suppl 1 4099 - http://fn.bmj.com/content/97/Suppl_1/A5.3.short 4100 - http://fn.bmj.com/content/97/Suppl_1/A5.3.full SO - Arch Dis Child Fetal Neonatal Ed2012 Apr 01; 97 AB - Introduction Elafin, a natural antimicrobial peptide, is an important component of the innate immune system. It is hypothesised that elafin production in cervico-vaginal fluid (CVF) will be altered in women at risk of spontaneous preterm birth (sPTB) associated with inflammation/infection. Aim To determine the relationship between CVF elafin concentrations and cervical length in women at high risk of sPTB. Methods Elafin concentrations were measured in 437 CVF samples (taken two-weekly between 14-28 weeks') from 74 pregnant women (asymptomatic, high risk for sPTB). Controls women who did not develop a short cervix (n=38); cases: women who developed a short cervix <25mm, n=36) and were randomised to either cerclage or vaginal progesterone (400 mg/od). Elafin was measured by ELISA. Logged data were analysed using random-effects interval regression. Results Concentrations of elafin were higher in the CVF of the short cervix group, regardless of gestation and treatment (ratio 2.71, CI 1.94 to 3.79, p<0.0005). Elafin concentrations predicted cervical shortening from 14 weeks' (n=11, ROC area = 1.00, p=0.0082), and remained high when cervical shortening was first detected (ratio 3.03 CI 1.92-4.81, p<0.0005). Elafin concentrations were unaltered by cerclage or progesterone (ratio 1.28, CI: 0.88-1.87, p=0.196). Raised elafin concentrations <24 weeks' were associated with SPTB <37 weeks (ratio 1.79, CI: 1.05-3.05, p=0.034). Conclusion These data suggest that CVF elafin concentrations may be useful for the early prediction of sPTB prior to cervical shortening.