“Blind” Vaginal Fetal Fibronectin as a Predictor of Spontaneous Preterm Delivery

Roman, Ashley S.; Koklanaris, Nikki; Paidas, Michael J.; Mulholland, Jeanine; Levitz, Mortimer; Rebarber, Andrei

doi:10.1097/01.aog.0000152385.46980.ef

Cited by 36 publications

(27 citation statements)

References 20 publications

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“…Ten studies (67%) were performed in the United States [28, 29, 32, 33, 35–39, 41], and one each in Italy [27], Sweden [30], Brazil [31], United Kingdom [34], and France [40]. The sample size ranged from 29 [28] to 169 [36] in asymptomatic women and from 38 [38] to 87 [41] in symptomatic women. Cervicovaginal fetal fibronectin was measured using enzyme-linked immunoabsorbent assay quantitative method (nine studies [28–30, 33, 35–39]), membrane immunoassay qualitative method (three studies [27, 31, 34]), and rapid TLi system qualitative method (one study [41]).…”

Section: Resultsmentioning

confidence: 99%

Cervicovaginal fetal fibronectin for the prediction of spontaneous preterm birth in multiple pregnancies: a systematic review and meta-analysis

Conde-Agudelo

Romero²

2010

The Journal of Maternal-Fetal & Neonatal Medicine

115

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Objective To investigate the accuracy of cervicovaginal fetal fibronectin in predicting preterm birth in women carrying multiple pregnancies. Methods Systematic review and meta-analysis of predictive test accuracy. Cohort or cross-sectional studies were identified through searches in databases, reference lists, proceedings, and reviews. Study selection, quality assessment, and data extraction were performed. We constructed summary receiver operating characteristic curves and calculated pooled sensitivities and specificities using a bivariate, random-effects meta-regression model. We also calculated summary likelihood ratios and post-test probabilities of preterm birth. Results Fifteen studies (11 in asymptomatic women and 4 in women with symptoms of preterm labor) involving 1221 women with multiple pregnancies were included. Among asymptomatic women with multiple or twin pregnancies, the pooled sensitivities, specificities, and positive and negative likelihood ratios for predicting preterm birth before 32, 34, and 37 weeks’ gestation ranged from 33% to 45%, 80% to 94%, 2.0 to 5.5, and 0.68 to 0.76, respectively. Among women with twin pregnancies and threatened preterm labor, the test was most accurate in predicting spontaneous preterm birth within 7 days of testing (pooled sensitivity, specificity, and positive and negative likelihood ratios of 85%, 78%, 3.9, and 0.20, respectively). Conclusions Cervicovaginal fetal fibronectin provides moderate to minimal prediction of preterm birth in women with multiple pregnancies. The test is most accurate in predicting spontaneous preterm birth within 7 days of testing in women with twin pregnancies and threatened preterm labor.

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Section: Resultsmentioning

confidence: 99%

Cervicovaginal fetal fibronectin for the prediction of spontaneous preterm birth in multiple pregnancies: a systematic review and meta-analysis

Conde-Agudelo

Romero²

2010

The Journal of Maternal-Fetal & Neonatal Medicine

115

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“…The samples were incubated in micro‐titer wells coated with FDC‐6 monoclonal antibody specific for fFN. fFN concentration ≥ 0.05 μg/mL was considered positive . Digital examination was done after collection of the swabs to assess the cervical changes and fetal membranes, to exclude women with established PTL and/or PPROM.…”

Section: Methodsmentioning

confidence: 99%

Blind vaginal fetal fibronectin swab for prediction of preterm birth

Farag

Mohammed

Ellaithy

et al. 2015

J of Obstet and Gynaecol

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Aim: To assess the accuracy of blind vaginal swab in diagnosis of preterm labor (PTL) and prediction of subsequent occurrence of preterm birth (PTB). Methods: Eligible women who presented at 24-34 weeks of gestation with threatened PTL had their cervicovaginal secretions sequentially sampled for fetal fibronectin (fFN) using two types of swabbing techniques. The first swab was a blind vaginal swab collected without the aid of speculum, while the second one was a routine cervicovaginal swab. All participants were followed up until delivery. Results: fFN in both swabs was significantly higher in women who delivered before term compared with women who delivered at term. On regression analysis, r 2 = 0.735 and 0.785 for blind vaginal and cervicovaginal swabs respectively, while on receiver operating characteristic analysis the area under curve was 0.965 and 0.977, respectively, without a statistically significant difference. Using an fFN cut-off of ≥0.05 μg/dL, the sensitivity, specificity, positive predictive value and negative predictive value of blind vaginal swab to predict PTB were 53.9%, 91.9%, 70.0% and 85.0%, respectively; while those for cervicovaginal swab were 58.3%, 94.7%, 77.8% and 87.8%, respectively. Conclusions: In women presenting at 24-34 weeks of gestation with threatened PTL, blind vaginal fFN swab is as effective as cervicovaginal swab to predict PTB, but it is easier to perform and does not require doctor supervision.

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“…In 2010, we published a systematic review and metaanalysis on the accuracy of cervicovaginal fetal fibronectin in predicting preterm birth in women with twin gestations.71 Fifteen studies (11 in asymptomatic women 30,32,38,45,72–78 and 4 in patients with symptoms of preterm labor 50,79–81 ) involving 1133 women with twin gestations were included in the review. Among asymptomatic women, cervicovaginal fetal fibronectin had limited accuracy in predicting preterm birth at <32, <34, and <37 weeks of gestation (pooled sensitivities, specificities, and positive and negative likelihood ratios ranging from 33–39%, 80–94%, 2.0–5.1, and 0.7–0.8, respectively).…”

Section: Biochemical Testsmentioning

confidence: 99%

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

Conde-Agudelo

Romero

2014

American Journal of Obstetrics and Gynecology

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The objective of this study was to determine the performance of biophysical and biochemical tests for the prediction of preterm birth in both asymptomatic and symptomatic women with twin gestations. We identified a total of 19 tests proposed to predict preterm birth, mainly in asymptomatic women. In these women, a single measurement of cervical length with transvaginal ultrasound before 25 weeks of gestation appears to be a good test to predict preterm birth. Its clinical potential is enhanced by the evidence that vaginal progesterone administration in asymptomatic women with twin gestations and a short cervix reduces neonatal morbidity and mortality associated with spontaneous preterm delivery. Other tests proposed for the early identification of asymptomatic women at increased risk of preterm birth showed minimal to moderate predictive accuracy. None of the tests evaluated in this review meet the criteria to be considered clinically useful to predict preterm birth among patients with an episode of preterm labor. However, a negative cervicovaginal fetal fibronectin test could be useful in identifying women who are not at risk for delivering within the next week, which could avoid unnecessary hospitalization and treatment. This review underscores the need to develop accurate tests for predicting preterm birth in twin gestations. Moreover, the use of interventions in these patients based on test results should be associated with the improvement of perinatal outcomes.

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“Blind” Vaginal Fetal Fibronectin as a Predictor of Spontaneous Preterm Delivery

Abstract: II-2.

Cited by 36 publications

References 20 publications

Cervicovaginal fetal fibronectin for the prediction of spontaneous preterm birth in multiple pregnancies: a systematic review and meta-analysis

Cervicovaginal fetal fibronectin for the prediction of spontaneous preterm birth in multiple pregnancies: a systematic review and meta-analysis

Blind vaginal fetal fibronectin swab for prediction of preterm birth

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

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