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External validation in cohort of 2,916 women undergoing digital cervical examination at 22–24 weeks.
Prospective validation of the Bishop Score (and comparison with the the digital Cervical Score) as a predictor of spontaneous preterm delivery before 35 weeks of gestation. Data from a cohort of 2,916 singleton pregnancies enrolled in a multicenter preterm prediction study were available. Patients underwent digital cervical examinations at 22–24 for calculation of Bishop Score and Cervical Score. Relationships between Bishop Score, Cervical Score, and spontaneous preterm delivery were assessed with multivariable logistic regression analysis, McNemar’s test, and receiver operating characteristics (ROC) curves to identify appropriate diagnostic thresholds and predictive capability.

RESULTS
One hundred twenty-seven of 2,916 patients (4.4%) undergoing cervical examination at 22–24 weeks had a spontaneous preterm delivery before 35 weeks. ROC curves indicated that optimal diagnostic thresholds for Bishop Score were at least 4 at 22–24 weeks. At 22–24 weeks’ gestation, the area under the ROC curve was significantly larger for the Bishop Score than for the Cervical Score (0.66 versus 0.61, p=0.03), indicating that overall, Bishop Score is a better diagnostic test at this gestation. However, McNemar’s test revealed that a Cervical Score < 1.5 was superior to a Bishop Score ≥ 4 (p<0.001) for the prediction of SPTD < 35 weeks’ gestation. For 86.6% of the patients, the timing of delivery was correctly predicted by both tests and for 4.4% of the patients both tests were wrong. For 7.4% of the patients the Cervical Score was correct while the Bishop Score was wrong, and for 1.6% of the patients the Bishop Score was correct while the Cervical Score was wrong.

CONCLUSIONS
Both cervical evaluations are associated with spontaneous preterm delivery in a singleton population, however, predictive capabilities for spontaneous preterm delivery were modest among women with low event prevalence. Overall, the Bishop Score performed better in the mid-trimester compared to the Cervical Score as a predictor of spontaneous preterm delivery before 35 weeks.
Autores de la investigación: Newman RB, Goldenberg RL, Lams JD, Meis PJ, Mercer BM, Moawad AH, Thom E, Miodovnik E, Caritis SN, Dombrowski M, and Thurnau GR.
Detalles
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Discriminación

Filas incluidas 0
C-index 0.66 ROC
Puntuación Brier No especificado
Puntuación Brier escalada No especificado

Gráfico de clasificación

No especificado

Calibración

Coeficiente de regresión 0
Intercepción 0
GOF de Hosmer-Lemeshow No especificado
 

Gráfico de calibración

No especificado

Histograma

No especificado

Curva de decisión

No especificado
Comparación
Población original del estudio: 500
Población del estudio de validación: 2916
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