Accuracy of cervico-vaginal fetal fibronectin test in predicting the risk of spontaneous preterm birth—a systematic review

Abstract

Objective To determine the accuracy with which a cervicovaginal fetal fibronectin test predicts spontaneous preterm birth in women with or without symptoms of preterm labour. Design Systematic quantitative review of studies of test accuracy. Data sources Medline, Embase, PASCAL, Biosis, Cochrane Library, Medion, National Research Register, SCISEARCH, conference papers, manual searching of bibliographies of known primary and review articles, and contact with experts and manufacturer. Study selection Two reviewers independently selected and extracted data on study characteristics, quality, and accuracy. Data extraction Accuracy data were used to form 2×2 contingency tables with spontaneous preterm birth before 34 and 37 weeks' gestation and birth within 7-10 days of testing (for symptomatic pregnant women) as reference standards. Data were pooled to produce summary receiver operating characteristic curves and summary likelihood ratios for positive and negative test results. Data synthesis 64 primary articles were identified, consisting of 28 studies in asymptomatic women and 40 in symptomatic women, with a total of 26 876 women. Among asymptomatic women the best summary likelihood ratio for positive results was 4.01 (95% confidence interval 2.93 to 5.49) for predicting birth before 34 weeks' gestation, with corresponding summary likelihood ratio for negative results of 0.78 (0.72 to 0.84). Among symptomatic women the best summary likelihood ratio for positive results was 5.42 (4.36 to 6.74) for predicting birth within 7-10 days of testing, with corresponding ratio for negative results of 0.25 (0.20 to 0.31). Conclusion Cervicovaginal fetal fibronectin test is most accurate in predicting spontaneous preterm birth within 7-10 days of testing among women with symptoms of threatened preterm birth before advanced cervical dilatation.

Evaluating the use of the QUiPP app and its impact on the management of threatened preterm labour: A cluster randomised trial

“…It also prevents necessary transfers as neonatal cots are blocked needlessly, resulting in more potentially hazardous ex utero transfers (EUTs) [9]. An increase in cervicovaginal quantitative fetal fibronectin (qfFN) and cervical length (CL) shortening are likely to represent a common pathway for pathological activation of labour and have the broadest evidence base [10][11][12]. Our research group developed the "QUantitative Innovation in Predicting Preterm birth" (QUIPP) app, which is a clinical decision support tool based on qfFN values, CL, and risk factors of women with symptoms or those considered to be at high risk of PTB, which is an accurate indicator of PTB risk [4,[13][14][15][16].…”

Fetal fibronectin FFN. Biochemical markers of preterm birth

“…The presence of fFN during these weeks, along with symptoms of labor, suggests that the "glue" may decay and there is early detection of possible preterm labor (8,11).…”