title: Fetal fibronectin as a predictor of spontaneous preterm birth: a European perspective.
abstract: Preterm birth (PTB) is estimated to account for 6-10% of all births worldwide with 13 million PTBs occurring annually and 1 million resulting in death. The diagnosis of spontaneous preterm labor and accurate prediction of preterm delivery is notoriously difficult. Identification of effective risk assessment markers can potentially improve outcomes by enabling targeted therapy while allowing efficient use of resources and avoiding unnecessary interventions. Advances in perinatal medicine have not reduced PTB and effective measures that improve outcome are yet to be established. However, considerable progress has been made in the development of accurate methods (fetal fibronectin and cervical length assessment) to predict PTB in both symptomatic and asymptomatic high-risk women. The excellent negative predictive value of fFN has the ability to facilitate decision-making regarding admission, in utero transfer, administration of antenatal corticosteroids and/or tocolysis and has been shown to be cost-effective. This review describes the European perspective on the use of fFN and describes ongoing European clinical studies, which are appropriately designed with meaningful endpoints, which will undoubtedly facilitate a better understanding of test accuracy and cost-effectiveness within different populations.
authors.affiliation: Department of Women's Health, St Thomas' Hospital, King's College London, London, UK. manju.chandiramani@kcl.ac.uk
authors.forename: Manju
authors.initials: M
authors.lastname: Chandiramani
authors.forename: Gian C
authors.initials: GC
authors.lastname: Di Renzo
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Gottschalk
authors.forename: Hanns
authors.initials: H
authors.lastname: Helmer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Henrich
authors.forename: Irene
authors.initials: I
authors.lastname: Hoesli
authors.forename: Ben
authors.initials: B
authors.lastname: Mol
authors.forename: Jane E
authors.initials: JE
authors.lastname: Norman
authors.forename: Stephen
authors.initials: S
authors.lastname: Robson
authors.forename: Steven
authors.initials: S
authors.lastname: Thornton
authors.forename: Andrew
authors.initials: A
authors.lastname: Shennan
mesh_terms: D054791:Cervical Length Measurement / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D005060:Europe; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis / Q000378:metabolism; D005333:Fetus / Q000378:metabolism*; D005353:Fibronectins / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D011296:Prenatal Diagnosis / Q000191:economics / Q000379:methods; D011379:Prognosis; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000175:diagnosis / Q000378:metabolism
chemical_list: D005353:Fibronectins