title: The Preterm Prediction Study: sequential cervical length and fetal fibronectin testing for the prediction of spontaneous preterm birth. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
abstract: OBJECTIVE
  This study was undertaken to further elucidate the pathogenesis of preterm birth by means of traditional risk factors and new markers for preterm birth derived from the Preterm Prediction Study.
  
  
  METHODS
  A total of 3076 women (2929 with singleton gestations and 147 with twin pregnancies) were categorized according to the presence of risk factors including black race, low body mass index, the presence of bacterial vaginosis, and previous preterm birth. At 24 and 28 weeks' gestation cervical length was measured and categorized as short (</=25 mm) or normal (>25 mm). Vaginal and cervical fetal fibronectin concentrations were measured at 24, 26, 28, and 30 weeks' gestation and results were categorized as positive (>/=50 ng/mL) or negative (<50 ng/mL).
  
  
  RESULTS
  At 24 to 26 weeks' gestation women with each of the risk factors were more likely to have positive fibronectin test results or to have a short cervix. Among women with negative fetal fibronectin results at 24 to 26 weeks' gestation those with a short cervix were more likely to have positive fetal fibronectin results at 28 to 30 weeks' gestation, and among those with normal cervical length those women who had positive fetal fibronectin results were more likely to have a short cervix at later evaluation. Most women who had positive fetal fibronectin results at 24 to 26 weeks' gestation had negative results at 28 to 30 weeks' gestation, whereas most but not all women who had a short cervix at 24 to 26 weeks' gestation still had a short cervix at 28 to 30 weeks' gestation. In each period women with both a positive fetal fibronectin result and a short cervix were at substantially increased risk of spontaneous preterm birth; women with either marker alone had intermediate and approximately equal risks of spontaneous preterm birth, and women without either marker had a low risk of spontaneous preterm birth.
  
  
  CONCLUSIONS
  Regardless of other risk factors, a short cervix predicts a subsequent positive fetal fibronectin result, and a positive fetal fibronectin result predicts subsequent cervical shortening. These data do not support a single sequence of events leading to spontaneous preterm birth.
authors.affiliation: Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: J D
authors.initials: JD
authors.lastname: Iams
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.forename: B M
authors.initials: BM
authors.lastname: Mercer
authors.forename: P J
authors.initials: PJ
authors.lastname: Meis
authors.forename: A H
authors.initials: AH
authors.lastname: Moawad
authors.forename: M
authors.initials: M
authors.lastname: Miodovnik
authors.forename: J P
authors.initials: JP
authors.lastname: VanDorsten
authors.forename: S N
authors.initials: SN
authors.lastname: Caritis
authors.forename: G R
authors.initials: GR
authors.lastname: Thurnau
authors.forename: M P
authors.initials: MP
authors.lastname: Dombrowski
authors.forename: J M
authors.initials: JM
authors.lastname: Roberts
authors.forename: D
authors.initials: D
authors.lastname: McNellis
mesh_terms: D015415:Biomarkers / Q000032:analysis; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000378:metabolism*; D005260:Female; D005353:Fibronectins; D006023:Glycoproteins / Q000032:analysis*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012307:Risk Factors; D014463:Ultrasonography; D014621:Vagina / Q000378:metabolism
chemical_list: D015415:Biomarkers; C403421:FFN protein, human; D005353:Fibronectins; D006023:Glycoproteins