Objective
Our objective was to systematically review the current medical literature to assess
the accuracy of the combination of fetal fibronectin (fFN) plus ultrasound assessment
of cervical length (CL) as screening tools for preterm labor and prediction of preterm
birth (PTB), and to compare this to the traditional clinical method of digital cervical
examination.
Study Design
We searched PubMed and Cochrane databases without date restriction using the key words
“fibronectin” and “cervical length,” limited to human studies published in English.
In all, 85 studies were identified and supplemented by 1 additional study found through
bibliographic search.
Results
Nine studies reported the association between fFN positivity plus CL measurement with
PTB in women presenting with symptomatic uterine contractions. We conducted an analytic
review of the sensitivity, specificity, positive predictive value, and negative predictive
value of fFN plus CL for PTB. Further metaanalysis was not performed due to study
heterogeneity, especially with respect to the range of gestational ages and variations
in cutoff values for the diagnosis of short cervix. Although the clinical diagnostic
methodology of preterm labor diagnosis by documenting uterine contractions plus cervical
change is currently standard practice, a newer approach combining fFN and CL screening
results in a higher sensitivity and positive predictive value for PTB risk while maintaining
high negative predictive value.
Conclusion
We conclude that this combined screening approach yields useful information regarding
short-term risks that can be used to guide acute management, and effectively identifies
a population at low risk in whom expensive and potentially dangerous interventions
could be avoided.
Key words
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Article Info
Publication History
Published online: December 13, 2012
Accepted:
December 5,
2012
Received in revised form:
November 19,
2012
Received:
September 5,
2012
Footnotes
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: DeFranco EA, Lewis DF, Odibo AO. Improving the screening accuracy for preterm labor: is the combination of fetal fibronectin and cervical length in symptomatic patients a useful predictor of preterm birth? A systematic review. Am J Obstet Gynecol 2013;208:233.e1-6.
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
