Advertisement

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

Published:December 13, 2012DOI:https://doi.org/10.1016/j.ajog.2012.12.015

      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 access
      One-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 & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Martin J.A.
        • Hamilton B.E.
        • Sutton P.D.
        • et al.
        Births: final data for 2005.
        Natl Vital Stat Rep. 2007; 56: 1-103
        • da Fonseca E.B.
        • Bittar R.E.
        • Carvalho M.H.
        • Zugaib M.
        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
        • Fonseca E.B.
        • Celik E.
        • Parra M.
        • Singh M.
        • Nicolaides K.H.
        Progesterone and the risk of preterm birth among women with a short cervix.
        N Engl J Med. 2007; 357: 462-469
        • Hassan S.S.
        • Romero R.
        • Vidyadhari D.
        • et al.
        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
        • Meis P.J.
        • Klebanoff M.
        • Thom E.
        • et al.
        Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.
        N Engl J Med. 2003; 348: 2379-2385
        • Odibo A.O.
        • Stamilio D.M.
        • Macones G.A.
        • Polsky D.
        17Alpha-hydroxyprogesterone caproate for the prevention of preterm delivery: a cost-effectiveness analysis.
        Obstet Gynecol. 2006; 108: 492-499
        • Guinn D.A.
        • Goepfert A.R.
        • Owen J.
        • Brumfield C.
        • Hauth J.C.
        Management options in women with preterm uterine contractions: a randomized clinical trial.
        Am J Obstet Gynecol. 1997; 177: 814-818
        • Eroglu D.
        • Yanik F.
        • Oktem M.
        • Zeyneloglu H.B.
        • Kuscu E.
        Prediction of preterm delivery among women with threatened preterm labor.
        Gynecol Obstet Invest. 2007; 64: 109-116
        • Hincz P.
        • Wilczynski J.
        • Kozarzewski M.
        • Szaflik K.
        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
        • Asakura H.
        • Fukami T.
        • Kurashina R.
        • Tateyama N.
        • Doi D.
        • Takeshita T.
        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
        • Audibert F.
        • Fortin S.
        • Delvin E.
        • et al.
        Contingent use of fetal fibronectin testing and cervical length measurement in women with preterm labor.
        J Obstet Gynaecol Can. 2010; 32: 307-312
        • Rose C.H.
        • McWeeney D.T.
        • Brost B.C.
        • Davies N.P.
        • Watson W.J.
        Cost-effective standardization of preterm labor evaluation.
        Am J Obstet Gynecol. 2010; 203: 250.e1-250.e5
        • Rozenberg P.
        • Goffinet F.
        • Malagrida L.
        • et al.
        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
        • Schmitz T.
        • Maillard F.
        • Bessard-Bacquaert S.
        • et al.
        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
        • Gomez R.
        • Romero R.
        • Medina L.
        • et al.
        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
        • Ness A.
        • Visintine J.
        • Ricci E.
        • Berghella V.
        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
        • Ben-Haroush A.
        • Poran E.
        • Yogev Y.
        • Glezerman M.
        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
        • Tsoi E.
        • Akmal S.
        • Geerts L.
        • Jeffery B.
        • Nicolaides K.H.
        Sonographic measurement of cervical length and fetal fibronectin testing in threatened preterm labor.
        Ultrasound Obstet Gynecol. 2006; 27: 368-372
        • Yoneyama K.
        • Kimura A.
        • Kogo M.
        • Kiuchi Y.
        • Morimoto T.
        • Okai T.
        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
        • Whiting P.
        • Rutjes A.W.
        • Reitsma J.B.
        • Bossuyt P.M.
        • Kleijnen J.
        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
        • Dean A.G.
        • Sullivan K.M.
        • Soe M.M.
        OpenEpi: Open Source Epidemiologic Statistics for Public Health, version 2.3.1.
        (Updated June 23, 2011) (Accessed Oct. 1, 2012)