title: Fetal fibronectin testing in patients with short cervix in the midtrimester: can it identify optimal candidates for ultrasound-indicated cerclage?
abstract: OBJECTIVE
  The objective of the study was to determine the relationship between fetal fibronectin (fFN) testing prior to ultrasound-indicated cerclage and obstetric outcome.
  
  
  METHODS
  Singleton pregnancies between 18 and 24 weeks' gestation with an ultrasound-diagnosed short cervix (< 25 mm) and funneling (> 25%) of the chorioamniotic membranes into the endocervical canal were analyzed. The fFN testing was performed and patients were randomized to cerclage or no-cerclage. Groups were stratified by fFN result. Cerclage patients were compared with no-cerclage patients. The primary outcome was delivery prior to 35 weeks' gestation.
  
  
  RESULTS
  Spontaneous preterm birth prior to 35 weeks' gestation occurred in 15 (44.1%) fFN-positive-cerclage patients and 16 (55.2%) fFN-positive no-cerclage patients (P = .45). Similarly, it occurred in 16 (17.8%) fFN-negative cerclage patients and 11 (17%) fFN-no-cerclage patients (P = .99).
  
  
  CONCLUSIONS
  fFN did not identify optimal candidates for cerclage. However, fFN testing before an ultrasound-indicated cerclage aids in counseling patients, anticipating the outcome of pregnancies complicated by cervical shortening.
authors.affiliation: Department of Obstetrics and Gynecology, New York University Medical Center, New York, NY, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Keeler
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Roman
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: Coletta
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Kiefer
authors.forename: Martin
authors.initials: M
authors.lastname: Feuerman
authors.forename: Orion A
authors.initials: OA
authors.lastname: Rust
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000378:metabolism; D005260:Female; D005333:Fetus; D005353:Fibronectins / Q000032:analysis*; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000209:etiology / Q000517:prevention & control*; D014463:Ultrasonography; D002577:Uterine Cervical Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014621:Vagina / Q000378:metabolism
chemical_list: D005353:Fibronectins