Objective. To assess the combined use of cervical length and cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in the prediction of preterm delivery in symptomatic women. Methods. Cervical length was prospectively measured in 102 consecutive singleton pregnancies with intact membranes and regular contractions at 24-32 weeks, and phIGFBP-1 was assessed in those with a cervix ≤30 mm. Results. Among women with a cervix >30 mm (n = 42), none delivered < 34 weeks or

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... hin 7 days. Among women with a cervical length ≤ 30 mm (n = 60), eight delivered < 34 weeks, four of which within 7 days. A positive phIGFBP-1 conferred a significantly increased risk of delivery before 34 weeks in women with a cervix ≤ 30 mm (likelihood ratio 2.32, 95% confidence interval 1.15-4.67), and a significantly increased risk of delivering within 7 days in the subgroup of women with a cervical length of 20-30 mm (likelihood ratio 3.64, 95% confidence interval 2.20-6.01). Conclusions. In symptomatic women with a cervical length > 30 mm the risk of preterm delivery is very low. In women with a cervix ≤30 mm, adding phIGFBP-1 assessment may improve the risk assessment for preterm delivery, and help to plan subsequent pregnancy management.