Effectiveness of Fetal Fibronectin Testing Compared with Digital Cervical Assessment of Women With Preterm Contractions

 

 Buy Article Permissions and Reprints

ABSTRACT

The purpose of this study is to determine the effectiveness of fetal fibronectin (FFN) compared to assessment of cervical dilation (CD) in clinical management of women with symptomatic preterm labor (PTL). Pregnant women presenting to Thomas Jefferson University Hospital between May 1, 2001 and November 30, 2002 with symptomatic PTL underwent FFN sampling and had a complete clinical evaluation including a pelvic bimanual examination. Inclusion criteria were singleton pregnancy, gestational age (GA) between 24⁰ and 33⁶ weeks, CD < 3 cm, and intact amniotic membranes. FFN samples were sent out and results were available within 4-12 hours. Clinical management including tocolysis, antenatal steroids, and hospitalization was determined based on digital CD assessment and FFN status. A dilated cervix was defined as CD > 1 cm. Ninety-three patients were included. Spontaneous preterm delivery (SPTD) at < 37 weeks occurred in 20 of 93 (21.5%) patients. Medical therapy use was significantly higher in patients with dilated cervix than in those with a closed cervix (all P values < 0.05). Tocolysis and steroid use in FFN-negative patients and FFN-positive patients were not significantly different. Furthermore, tocolytic use was higher in FFN-negative patients than in women with positive FFN (50% versus 42.1%; P = 0.53). Use of antenatal steroids was similar in patients with CD ≥ 1 cm and a positive FFN (54.5% versus 47.4%; P = 0.92). Compared with FFN-negative patients, women with closed cervix were less likely to undergo interventions. In symptomatic PTL patients, CD determined clinical management more than FFN status. Overall, the use of FFN was not effective in decreasing “unnecessary” clinical interventions.

REFERENCES

• 1 Martin J A, Hamilton B E, Sutton P D, Ventura S J, Menacker F, Kirmeyer S. Births: final data for 2004.  Natl Vital Stat Rep. 2006;  55 1-101
  PubMedGoogle Scholar
• 2 McLean M, Walters W A, Smith R. Prediction and early diagnosis of preterm labor: a critical review.  Obstet Gynecol Surv. 1993;  48 209-225
  PubMedGoogle Scholar
• 3 Lockwood C J, Kuczynski E. Markers of risk for preterm delivery.  J Perinat Med. 1999;  27 5-20
  CrossrefPubMedGoogle Scholar
• 4 Lu G C, Goldenberg R L, Cliver S P, Kreaden U S, Andrews W W. Vaginal fetal fibronectin levels and spontaneous preterm birth in symptomatic women.  Obstet Gynecol. 2001;  97 225-228
  CrossrefPubMedGoogle Scholar
• 5 Goldenberg R L, Mercer B M, Meis P J, Copper R L, Das A, McNellis D. for The NICHD Maternal Fetal Medicine Units Network . The preterm prediction study: fetal fibronectin testing and spontaneous preterm birth.  Obstet Gynecol. 1996;  87 643-648
  CrossrefPubMedGoogle Scholar
• 6 Goldenberg R L, Thom E, Moawad A H, Johnson F, Roberts J, Caritis S N. for the NICHD Maternal Fetal Medicine Units Network . The preterm prediction study: fetal fibronectin, bacterial vaginosis, and peripartum infection.  Obstet Gynecol. 1996;  87 656-660
  PubMedGoogle Scholar
• 7 Peaceman A M, Andrews W W, Thorp J M et al.. Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial.  Am J Obstet Gynecol. 1997;  177 13-18
  CrossrefPubMedGoogle Scholar
• 8 Lukes A S, Thorp Jr J M, Eucker B, Pahel-Short L. Predictors of positivity for fetal fibronectin in patients with symptoms of preterm labor.  Am J Obstet Gynecol. 1997;  176 639-641
  CrossrefPubMedGoogle Scholar
• 9 Rinehart B K, Terrone D A, Isler C M, Barrilleaux P S, Bufkin L, Morrison J C. Pregnancy outcome in women with preterm labor symptoms without cervical change.  Am J Obstet Gynecol. 2001;  184 1004-1007
  CrossrefPubMedGoogle Scholar
• 10 Joffe G M, Jackes D, Bemis-Heys R, Burton R, Skram B, Shelburne P. Impact of the fetal fibronectin assay on admissions for preterm labor.  Am J Obstet Gynecol. 1999;  180 581-586
  CrossrefPubMedGoogle Scholar
• 11 Committee on Obstetric Practice . ACOG Committee opinion: antenatal corticosteroid therapy for fetal maturation.  Obstet Gynecol. 2002;  99 871-873
  CrossrefPubMedGoogle Scholar
• 12 Honest H, Bachmann L M, Gupta J K, Kleijnen J, Khan K S. Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review.  BMJ. 2002;  325 289-290
  CrossrefPubMedGoogle Scholar
• 13 Howard K I, Moras K, Brill P L, Martinovich Z, Lutz W. Evaluation of psychotherapy: efficacy, effectiveness, and patient progress.  Am Psychol. 1996;  51 1059-1064
  CrossrefPubMedGoogle Scholar
• 14 Campbell D T, Stanley J C. Experimental and quasi-experimental designs for research. Chicago; Rand McNally 1966
  Google Scholar
• 15 Swamy G K, Simhan H N, Gammill H S, Heine R P. Clinical utility of fetal fibronectin for predicting preterm birth.  J Reprod Med. 2005;  50 851-856
  PubMedGoogle Scholar
• 16 Voluménie J L, Guibourdenche J, Doridot V et al.. Failure of cervical fibronectin to predict premature delivery in a population of monofetal pregnancies with idiopathic preterm labor.  Eur J Obstet Gynecol Reprod Biol. 2001;  97 35-39
  CrossrefPubMedGoogle Scholar
• 17 Coleman M A, McCowan L M, Pattison N S, Mitchell M. Fetal fibronectin detection in preterm labor: evaluation of a prototype bedside dipstick technique and cervical assessment.  Am J Obstet Gynecol. 1998;  179 1553-1558
  CrossrefPubMedGoogle Scholar

Dr. Julio Mateus

1200 Old York Road

Suite 109, Abington, PA 19001