[Predicating imminent preterm labour based on a determination of foetal fibronectin in a vaginal smear].
OBJECTIVE
To determine the prognostic value of foetal fibronectin and cervical length for predicting imminent preterm labour among Dutch women, who in the Netherlands normally undergo a digital examination of the cervix prior to referral to a hospital or university medical centre.


METHODS
Prospective observational cohort study.


METHODS
Pregnant women with symptoms of preterm labour and a gestational age between 24 and 34 weeks were included. A fibronectin smear was taken from them and the cervical length was measured. Primary outcome was delivery within 7 days after inclusion. Sensitivity, specificity and a receiver-operating characteristics (ROC) curve were calculated.


RESULTS
13 (12%) of the 108 included patients delivered spontaneously within 7 days after inclusion. The fibronectin test had a sensitivity of 92% and specificity of 60%. The positive and negative predictive values were 27% and 98% respectively. For women who had undergone a digital examination prior to testing, the predictive value was slightly less but the difference was not significant. Although measurement of the cervical length scarcely had a predictive value, none of the patients with a cervical length above 35 mm delivered within 7 days.


CONCLUSIONS
In women with an imminent preterm labour, a negative fibronectin test virtually ruled out delivery within 7 days. The fibronectin test can therefore also be used in the Dutch situation. In women with a cervix length greater than 35 mm, the chance of a preterm labour within 7 days is very small and a fibronectin test does not need to be performed in their case.
Máxima Medisch Centrum, Veldhoven, afd. Obstetrie en Gynaecologie, Eindhoven, The Netherlands. f.wilms@mmc.nl
Femke F
FF
Wilms
Giel
G
van Stralen
Martina M
MM
Porath
Dimitri N M
DN
Papatsonis
S Guid G
SG
Oei
Ben-Willem
BW
Mol
Sicco
S
Scherjon
D015415:Biomarkers; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D015331:Cohort Studies; D005260:Female; D005333:Fetus / Q000378:metabolism*; D005353:Fibronectins / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000000981:diagnostic imaging / Q000378:metabolism*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014626:Vaginal Smears
D015415:Biomarkers; D005353:Fibronectins