Prediction of spontaneous preterm birth by fetal fibronectin and uterine activity

Abstract

Both the home uterine contraction assessment and fetal fibronectin accurately predicted preterm birth before 34 weeks. When both tests were combined, the predictive ability improved substantially.

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

“…2 For predicting spontaneous delivery before 34 weeks, "blind" sampling has a specificity of 88.3% compared with 89% reported in a recent metaanalysis 17 and a negative predictive value of 94.1% compared with a range of 88.7-97.8% reported in similar populations. 3,12 Although the sensitivity of "blind" sampling is slightly lower than with speculum-directed testing (for delivery within 14 days, 52% compared with 67%; 17 for delivery before 34 weeks, 44.7% compared with 53% 17 ), the primary utility of testing is its negative predictive value, regardless of sampling technique.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12]15 The primary benefit of the test is in its negative predictive value, that is, identifying patients who will not deliver preterm or within a specified time interval. As a result, patients with negative test results can be managed on outpatient basis and avoid unnecessary-and often poorly proven-interventions such as tocolysis and bedrest.…”

“…Most studies describe a technique that requires a speculum examination with visually directed sampling of secretions in the posterior fornix and/or cervical os. [1][2][3][4][5][6][7][8][9][10][11][12] Many patients are reluctant to undergo this invasive examination at regular 14-to 21-day intervals, thus limiting the use of this test in clinical practice. Furthermore, the speculum examination must be performed by a trained medical professional.…”

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

“…Figure 2 summarises the quality of methods. Thirteen (19%) studies, seven among asymptomatic [39][40][41][42][43][44][45] and six among symptomatic women, [46][47][48][49][50][51] fulfilled all four criteria for good quality. All studies except three [52][53][54] (which accounted for 0.28% of the 22 390 women in our review) used thresholds of 50 ng/ml to indicate an abnormal test result.…”

“…Eight studies examined the use of fibronectin as a screening tool in low risk pregnancy and nine as a selective screening tool in high risk pregnancy. Most studies 75 Goldenberg (1996) 75 Goldenberg (1996) 75 Goldenberg (1996) 75 Chang (1997) 25 Nageotte (1994) 66 Oliveira (1998) 67 Morrison (1996) 40 Morrison (1996) 40 Goldenberg (2000) 77 Heath (2000) 45 Tolino (1996) 41 Goldenberg (1997) 76 Wennerholm (1997) 94 Goldenberg (1996) Tolino (1996) 41 Wennerholm (1997) 94 Hux (1995) 78 Overall (95% CI) were carried out during the second trimester or early in the third trimester. Meta-regression analysis showed the accuracy of the test did not depend on the method of testing, how often the test was done, classification of risk, or gestation at testing.…”