THE PRETERM PREDICTION STUDY - FETAL FIBRONECTIN, BACTERIAL VAGINOSIS, AND PERIPARTUM INFECTION

Objective: To determine the relation between vaginal and upper genital tract infection and cervical-vaginal fetal fibronectin levels. Method s: We screened 2899 women at ten centers every 2 weeks from 23-24 to 3 0 weeks' gestation for cervical and vaginal fetal fibronectin. A posit ive test was defined as a level of at least 50 ng/mL. The relation bet ween a positive test and bacterial vaginosis at 23-24 weeks and clinic al or histologic chorioamnionitis at delivery plus neonatal sepsis was determined. Results: Fetal fibronectin was present in 4.0% of cervica l and/or vaginal samples at 23-24 weeks and was nearly twice as common in women with bacterial vaginosis. Adjusting for the presence of bact erial vaginosis, race, and parity, women positive for fetal fibronecti n were much more likely to have clinical chorioamnionitis (mean +/- st andard deviation gestational age 30.6 +/- 4.1 weeks), with an odds rat io of 16.4 and 95% confidence interval of 7.1-37.8, and neonatal sepsi s (6.3 and 2.0-20.0, respectively), than those who were fetal fibronec tin-negative. A positive cervical fetal fibronectin test was a better predictor of clinical chorioamnionitis and neonatal sepsis than was a vaginal test or a combination of vaginal and cervical tests. Among 40 women who delivered before 32 weeks and had placental histology availa ble for evaluation, ten had a positive cervical and/or vaginal fetal f ibronectin test before delivery; all ten had histologic evidence of ch orioamnionitis, compared with only 13 of 30 women (43%) who were fetal fibronectin-negative (P = .02). Conclusion: Women with bacterial vagi nosis were more likely to have a positive fetal fibronectin test than uninfected women. Women with a positive fetal fibronectin test who del ivered before 32 weeks' gestation all had evidence of histologic chori oamnionitis. Women positive for fetal fibronectin also had a 16-fold i ncrease in clinical chorioamnionitis and a sixfold increase in neonata l sepsis. There is strong evidence that upper genital tract infection and cervical and/or vaginal fetal fibronectin are closely linked.