Use of Fetal Fibronectin in Clinical Practice

Abstract

Preterm delivery remains a worldwide problem hindered by many unknowns, not the least of which is an inability to detect patients at risk for this complication of pregnancy. A unique form of fibronectin identified in the extracellular matrix surrounding the extravillous trophoblast at the uteroplacental junction contains an epitope called the "oncofetal domain," which is recognized by the monoclonal antibody FDC-6. When detected in cervicovaginal secretions of both symptomatic patients as well as asymptomatic women who have risk factors for early deliver, fetal fibronectin seems to be a marker for preterm delivery with a good positive predictive value (40-60 percent). A negative result has a negative predictive value of 99.5 percent for birth within 7 days and 92 percent for delivery before 37 weeks in those patients with signs and symptoms of preterm labor. In low-risk asymptomatic patients, the positive predictive value is lower (15-25 percent), but is important because women in this group, destined to deliver as a consequence of preterm labor, may have no other signs or symptoms to forebode preterm delivery. Fetal fibronectin testing could also be important in women in spurious preterm labor who may eventually deliver before 37 weeks' gestation. Although specific interventional studies are still needed, this test is an important step forward in the provider's armamentarium to reduce the impact of a preterm delivery.

Plasma Fibronectin Concentration in Obese/Overweight Pregnant Women: A Possible Risk Factor for Preeclampsia

“…The synthesis and release of fibronectin into body fluid has been associated with normal growth of extravillus trophoblasts and the placenta [29,30]. These sources of fibronectin may contribute to its increasing level in maternal blood as normal pregnancy progresses.…”

Fetal fibronectin detection for preterm birth prediction

“…If the fFN level in the cervicovaginal secretions of 20-to 37-week pregnant women is ≥50 μg/L, the likelihood of preterm delivery is high (Ahner et al, 1995). Some studies (Ahner et al, 1995;Ascarelli and Morrison, 1997) showed that the chorionic and decidual fusion is not sufficiently close during normal early pregnancy, and fFN would leak with cervicovaginal secretions before 20 weeks of gestation. The chorionic and decidual fusion is completed after 20 weeks of pregnancy, and the fFN is then rarely detected in cervicovaginal secretions.…”

Protein engineering of a fibroblast growth factor-1 fusion protein with cell adhesive activity

“…Clinically, new capillaries first become visible in the wound bed 325 days after injury, and their appearance is synonymous with granulation, the creation of a provisional matrix comprised of proliferating blood vessels, migrating fibroblasts and new collagen. FGF1 is a potent pleiotropic mitogen endowed with a potent angiogenic activity in vitro and in vivo [12,13]. It acts synergistically with vascular endothelial growth factor to stimulate new vessel growth, which is required during tissue repair.…”