PREDICTION OF SPONTANEOUS PRETERM BIRTH BY FETAL FIBRONECTIN AND UTERINE ACTIVITY

Citation
Jc. Morrison et al., PREDICTION OF SPONTANEOUS PRETERM BIRTH BY FETAL FIBRONECTIN AND UTERINE ACTIVITY, Obstetrics and gynecology, 87(5), 1996, pp. 649-655
Citations number
18
Categorie Soggetti
Obsetric & Gynecology
Journal title
ISSN journal
00297844
Volume
87
Issue
5
Year of publication
1996
Part
1
Pages
649 - 655
Database
ISI
SICI code
0029-7844(1996)87:5<649:POSPBB>2.0.ZU;2-#
Abstract
Objective: To evaluate the usefulness of fetal fibronectin and home ut erine contraction assessment in predicting preterm birth (before 34 we eks) in at-risk asymptomatic women. Methods: One hundred fifty women w ere enrolled prospectively; five were lost to follow-up, leaving 145 w omen available for analysis. Because patients with preterm labor befor e 34 weeks' gestation most commonly develop this problem after 28 week s, the period of 26-28 weeks' gestation was selected prospectively as the first window for prediction and study analysis. Eighty-five of 145 asymptomatic women at high risk for preterm birth had both home uteri ne contraction assessment of 2 hours per day and one or more cervical sampling(s) for fetal fibronectin measurement at 26-28 weeks. A positi ve home uterine contraction assessment was defined as contractions exc eeding two per hour averaged over the 2-week study interval. Positive fetal fibronectin was defined as greater than 50 ng/mL. Results: Fourt een of the 85 women (16.5%) delivered before 34 weeks. Home uterine co ntraction assessment alone had a sensitivity, specificity, positive pr edictive value, and negative predictive value for preterm birth of 64, 85, 45, and 92%, respectively; fetal fibronectin alone was associated with values of 43, 89, 43, and 89%, respectively. A positive home ute rine contraction assessment was associated with a relative risk (RR) f or preterm birth of 5.9 (95% confidence interval [CI] 2.4-14.2), where as a positive fetal fibronectin demonstrated an RR of 3.8 (95% CI 1.5- 9.4). When both assessments were positive, all patients delivered befo re 34 weeks and there was an RR of 27.0 (95% CI 8.7-84.1) compared wit h those with both tests being negative. Only two patients with both te sts negative delivered before 34 weeks (negative predictive value 96%) . Conclusion: Both the home uterine contraction assessment and fetal f ibronectin accurately predicted preterm birth before 34 weeks. When bo th tests were combined, the predictive ability improved substantially.