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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Births: final data for 2005.Natl Vital Stat Rep. 2007; 56: 1-103
- Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study.Am J Obstet Gynecol. 2003; 188: 419-424
- Progesterone and the risk of preterm birth among women with a short cervix.N Engl J Med. 2007; 357: 462-469
- Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial.Ultrasound Obstet Gynecol. 2011; 38: 18-31
- Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.N Engl J Med. 2003; 348: 2379-2385
- 17Alpha-hydroxyprogesterone caproate for the prevention of preterm delivery: a cost-effectiveness analysis.Obstet Gynecol. 2006; 108: 492-499
- Management options in women with preterm uterine contractions: a randomized clinical trial.Am J Obstet Gynecol. 1997; 177: 814-818
- Prediction of preterm delivery among women with threatened preterm labor.Gynecol Obstet Invest. 2007; 64: 109-116
- Two-step test: the combined use of fetal fibronectin and sonographic examination of the uterine cervix for prediction of preterm delivery in symptomatic patients.Acta Obstet Gynecol Scand. 2002; 81: 58-63
- Significance of cervical gland area in predicting preterm birth for patients with threatened preterm delivery: comparison with cervical length and fetal fibronectin.Gynecol Obstet Invest. 2009; 68: 1-8
- Contingent use of fetal fibronectin testing and cervical length measurement in women with preterm labor.J Obstet Gynaecol Can. 2010; 32: 307-312
- Cost-effective standardization of preterm labor evaluation.Am J Obstet Gynecol. 2010; 203: 250.e1-250.e5
- Evaluating the risk of preterm delivery: a comparison of fetal fibronectin and transvaginal ultrasonographic measurement of cervical length.Am J Obstet Gynecol. 1997; 176: 196-199
- Selective use of fetal fibronectin detection after cervical length measurement to predict spontaneous preterm delivery in women with preterm labor.Am J Obstet Gynecol. 2006; 194: 138-143
- Cervicovaginal fibronectin improves the prediction of preterm delivery based on sonographic cervical length in patients with preterm uterine contractions and intact membranes.Am J Obstet Gynecol. 2005; 192: 350-359
- Does knowledge of cervical length and fetal fibronectin affect management of women with threatened preterm labor?.Am J Obstet Gynecol. 2007; 197: 426.e1-426.e7
- Vaginal fetal fibronectin evaluation before and immediately after ultrasonographic vaginal cervical length measurements in symptomatic women at risk of preterm birth: a pilot study.J Matern Fetal Neonatal Med. 2010; 23: 854-856
- Sonographic measurement of cervical length and fetal fibronectin testing in threatened preterm labor.Ultrasound Obstet Gynecol. 2006; 27: 368-372
- Clinical predictive factors for preterm birth in women with threatened preterm labor or preterm premature ruptured membranes?.Aust N Z J Obstet Gynaecol. 2009; 49: 16-21
- The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.BMC Med Res Methodol. 2003; 3: 25
- OpenEpi: Open Source Epidemiologic Statistics for Public Health, version 2.3.1.(Updated June 23, 2011) (Accessed Oct. 1, 2012)
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.
