QUANTITATIVE-DETERMINATION OF FETAL FIBRO NECTIN IN THE CERVICOVAGINAL SMEAR - A NEW MARKER FOR ASSESSING PREMATURE BIRTH RISK IN CASE OF PREMATURE LABOR

There is a well-known correlation between ascending infection and pret erm labour. Nevertheless, up to now an exact method to identify patien ts which are at high risk for preterm labour does not exist. Fetal fib ronectin is an extracellular matrix protein, which is produced by feta l membranes. High concentrations are present in amniotic fluid, but no t in cervical secretions in uncomplicated pregnancies (only in 3-4%). If there is an inflammatory mediated damage to fetal membranes (amnion /chorion) or a mechanical disruption caused by preterm contractions, f etal fibronectin should be released into the cervix and vagina. A pros pective clinical study measuring quantitatively the content of fFN in cervicovaginal secretions in patients with preterm labour (n = 43), pr eterm rupture of membranes (n = 15) and 20 controls was undertaken. In 16 patients frequent specimen could be obtained over a period of seve ral weeks. 14 of the 34 patients with preterm labour, which could be o bserved until delivery, delivered before term (<37. WOP). In 13 fFN wa s present in a concentration > 75 ng/ml (sensitivity: 92,4%). 13 patie nts were negative for fFN and only one of these patients delivered bef ore term (92% chance of term delivery in absence of fFN in cervicovagi nal fluids). In 8 patients with beta-adrenergic treatment fFN was pres ent. All patients delivered before term. The 15 patients with PROM had very high concentrations of fFN with a medium concentration of 967,3 ng/ml. 18 of the 20 control patients were negative for fFN (<75 ng/ml) , 2 had a slightly elevated concentration of 84 and 85 ng/ml. All deli vered at term. In summary, the quantitative measurement of fFN in cerv icovaginal fluids in patients with preterm contractions is a reliable diagnostic method to detect patients at high risk for preterm labour. If fFN is present, preterm labour will occur in most cases.