FETAL FIBRONECTIN, ENDOTOXIN, BACTERIAL VAGINOSIS AND CERVICAL LENGTHAS PREDICTORS OF PRETERM BIRTH AND NEONATAL MORBIDITY IN TWIN PREGNANCIES

Objective To evaluate the predictive values of fetal fibronectin, bact erial vaginosis, endotoxin and cervical length for preterm birth (< 35 and < 37 weeks) and neonatal morbidity in twin pregnancies. Participa nts One-hundred and twenty-one women with twin pregnancies recruited i nto a prospective longitudinal study at three antenatal clinics in the southwest of Sweden. Methods Cervical or vaginal fluid was sampled an d de?determined for fetal fibronectin (greater than or equal to 0.05 m u g/mL was used as cutoff), endotoxin (greater than or equal to 100 pg /mL) and bacterial vaginosis (presence of clue cells) at two week inte rvals from 24 to 34 weeks of gestation, The cervical length was measur ed with transvaginal sonography at the same time intervals. Main outco me measures Occurrence of preterm birth (< 35 and < 37 weeks of gestat ion) and neonatal morbidity. Results All positive fetal fibronectin sa mples obtained at screening between 24 and 34 weeks predicted birth < 35 weeks (RR 18.0; 95% CI 2.2-145.9), A positive fetal fibronectin at 28 weeks of gestation predicted delivery < 35 weeks (RR 6.3; 95% CI 2. 6-15.1) with a sensitivity, specificity, positive and negative predict ive value Of 50.0, 92.0, 62.5 and 87.3%, respectively. An independent association between fetal fibronectin at 28 weeks and preterm birth (< 35 weeks) was verified with logistic regression (P = 0.03). A positiv e fetal fibronectin at 28 weeks of gestation predicted neonatal morbid ity (RR 5.1; 95% CI 2.4-11.0) and a longer period of care at the neona tal intensive care unit. The predictive power of cervical sonography w as generally low but cervical length (cutoff less than or equal to 33 mm) measured at 28 weeks of gestation was significantly associated wit h birth < 37 weeks (RR 2.2; 95% OI 1.1-4.2). The presence of endotoxin correlated to bacterial vaginosis, bat :these tests were not signific antly related to preterm birth or neonatal morbidity. Conclusions Feta l fibronectin predicted preterm birth and neonatal morbidity in twin p regnancies. The predictive value of cervical length determinations was low. Endotoxin and bacterial vaginosis had no predictive power for pr eterm delivery in this study.