The value of fetal fibronectin in cervical and vaginal secretions and of ultrasonographic examination of the uterine cervix in predicting premature delivery for patients with preterm labor and intact membranes

• Published in: American journal of obstetrics and gynecology Vol. 175; no. 5; pp. 1146 - 1151
• Main Authors: Rizzo, Giuseppe, Capponi, Alessandra, Arduini, Domenico, Lorido, Carmine, Romanini, Carlo
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-11-1996; Elsevier
• Subjects: Adult; Biological and medical sciences; Cervix Uteri - chemistry; Cervix Uteri - diagnostic imaging; Female; fetal fibronectin; Fibronectins - analysis; Gynecology. Andrology. Obstetrics; Humans; Management. Prenatal diagnosis; Medical sciences; Obstetric Labor, Premature - diagnosis; Pregnancy; Pregnancy. Fetus. Placenta; Preterm labor; transvaginal ultrasonography; Ultrasonography; uterine cervix; Vagina - chemistry; fetal fibronectin; Preterm labor; uterine cervix; transvaginal ultrasonography; Sonography; Human; Measurement; Prognosis; Pregnancy disorders; Samplings; Premature delivery; Cervical smear; Uterine cervix; Fibronectin; Pregnancy; Vaginal route; Echography; Delivery disorders; Female; Fetus; Comparative study
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(96)70020-0

OBJECTIVE: We compared the diagnostic performances of fetal fibronectin assay of cervical and vaginal secretions and of transvaginal ultrasonographic evaluation of the uterine cervix in the prediction of preterm delivery of patients presenting with preterm labor and intact membranes.
STUDY DESIGN: One hundred eight patients admitted to the hospital for preterm labor and with intact membranes underwent assay of fibronectin in the cervical and vaginal secretions and transvaginal ultrasonographic evaluation of the uterine cervix. The ultrasonographic parameters evaluated were cervical length, presence of funneling, and cervical index ([Funnel length + 1]/Cervical length). Outcome measures were occurrence of preterm delivery, defined as birth before the thirty-seventh week of gestation, and the admission-to-delivery interval.
RESULTS: Forty-seven patients (43.5%) were delivered preterm. Receiver characteristic curve analysis showed that a level of fetal fibronectin in cervical secretions
≥60 ng/ml had the highest diagnostic performance in predicting preterm delivery (sensitivity 80.9%, specificity 83.6%). Multiple stepwise logistic regression analysis indicated that the cervical index significantly improved the prediction of preterm delivery achieved by the fetal fibronectin assay. In patients with cervical secretion fibronectin levels
≥60 ng/ml, survival analysis showed a shorter admission-to-delivery interval in the presence of an abnormal cervical index (
p
≤ 0.001).
CONCLUSIONS: The assay of fetal fibronectin in cervical secretions is more accurate than ultrasonographic evaluation of the uterine cervix in the prediction of preterm delivery. Combined use of the fetal fibronectin assay and the cervical index improves the diagnostic efficiency and allows prediction of the admission-to-delivery interval, identifying a subgroup of patients who may require aggressive treatment. (Am J Obstet Gynecol 1996;175:1146-51)