Fetal fibronectin as predictor of successful induction of mid-trimester abortion.
BACKGROUND
Fetal fibronectin (FFN) in cervical secretion is one of the most effective markers of pre-term and term delivery. The presence of FFN in cervicovaginal secretions has recently been shown to reflect cervical state and an uncomplicated induction of labor at term. This study was designed to determine whether FFN could be a biochemical marker to predict the response to prostaglandins in early mid-trimester abortion.


METHODS
The presence of cervical FFN was evaluated by means of qualitative rapid immunoassay in 270 patients, who required second trimester termination of pregnancy at the Department of Gynecology and Obstetrics, University of Naples 'Federico II'. According to the standard protocol of our unit, women received 1.0 mg of gemeprost intravaginally at 3-hr intervals up to a maximum of five suppositories. The induction-to-abortion interval and the percentage of successful abortions within 24 hr in women in the positive FFN group (n=19) were compared with those in the negative FFN group (n=251).


RESULTS
FFN in the cervical secretions was present in seven women (10.2%) at 16-weeks gestation, in seven women (7.5%) at 17-weeks gestation, and in five women (4.5%) at 18-week gestation. Final termination rates were 13 (68.4%) in the fibronectin-positive group and 177 (70.5%) in the fibronectin-negative group. The median abortion interval was similar (14.7 versus 15.1 hr) in both groups.


CONCLUSIONS
A positive cervical fetal fibronectin test does not predict a successful medical termination of pregnancy in second trimester abortion. In this setting, the role of fetal cervical fibronectin in cervical ripening is, therefore, questionable.
Mercorio
Francesco
F
Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples Federico II, Italy. fmercorio@libero.it
Mercorio
Antonio
A
Votino
Carmela
C
Di Spiezio Sardo
Attilio
A
Barba
Gian Vincenzo
GV
Nappi
Carmine
C
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000025:Abortion, Eugenic; D000328:Adult; D000527:Alprostadil / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015415:Biomarkers / Q000032:analysis; D002582:Cervix Mucus / Q000737:chemistry*; D005260:Female; D005353:Fibronectins / Q000032:analysis*; D006023:Glycoproteins / Q000032:analysis*; D020073:Gravidity; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D015415:Biomarkers; C403421:FFN protein, human; D005353:Fibronectins; D006023:Glycoproteins; C021182:gemeprost; D000527:Alprostadil