Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial
| Autor: | L. Coultrip, N. Eriksen, John M. Thorp, R. H. Holbrook, J. Elliott, S. P. Cliver, William W. Andrews, Jay D. Iams, C. Ingardia, Alan M. Peaceman, A. Lukes, M. Pietrantoni |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
medicine.medical_specialty Pregnancy Trimester Third Cervical dilation Population Fetus Obstetric Labor Premature Predictive Value of Tests Pregnancy Risk Factors medicine Humans education Fetal Death Probability Gynecology education.field_of_study Fetal fibronectin Obstetrics business.industry Pregnancy Outcome Obstetrics and Gynecology Antibodies Monoclonal Odds ratio medicine.disease Confidence interval Fibronectins Relative risk Pregnancy Trimester Second Vagina Regression Analysis Female business |
| Zdroj: | American journal of obstetrics and gynecology. 177(1) |
| ISSN: | 0002-9378 |
| Popis: | Our aim was to determine whether the presence of fetal fibronectin in vaginal secretions of patients with symptoms suggestive of preterm labor predicts preterm delivery.Patients who were examined at the hospital between 24 weeks' and 34 weeks 6 days' gestation with intact membranes, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilation3 cm were recruited at 10 sites. Swabs of the posterior fornix were assayed for the presence of fetal fibronectin by monoclonal antibody assay, with a positive result defined asor = 50 ng/ml. Results were not available to the managing physicians. Tocolysis was used when clinically indicated after specimen collection.A total of 763 patients had fetal fibronectin results and pregnancy outcome data available for analysis. Fetal fibronectin was detected in specimens from 150 (20%) patients. Compared with patients who had negative results, patients who had positive results for fetal fibronectin were more likely to be delivered within 7 days (relative risk 25.9 [95% confidence interval 7.8 to 86]), within 14 days (relative risk 20.4 [95% confidence interval 8.0 to 53]), and before 37 completed weeks (relative risk 2.9 [95% confidence interval 2.2 to 3.7]). The negative predictive values for delivery within 7 days, within 14 days, and at37 weeks were 99.5%, 99.2%, and 84.5%, respectively. When we used multiple logistic regression analysis to control for potential confounding variables among singleton pregnancies, only the presence of fetal fibronectin (odds ratio 48.8, 95% confidence interval 7.4 to 320), prior preterm birth (odds ratio 8.3, 95% confidence interval 1.5 to 46.6), and tocolysis (odds ratio 4.1, 95% confidence interval 1.0 to 16.0) were associated with birth within 7 days; fetal fibronectin (odds ratio 3.6, 95% confidence interval 2.2 to 5.9), prior preterm birth (odds ratio 2.5, 95% confidence interval 1.4 to 4.4), cervical dilatation1 cm (odds ratio 2.9, 95% confidence interval 1.6 to 5.2), and tocolysis (odds ratio 4.5, 95% confidence interval 2.8 to 7.2) were all independently associated with delivery before 37 weeks.In a population of patients with symptoms, the presence of fetal fibronectin in vaginal secretions best defines a subgroup at increased risk for delivery within 7 days; the high negative predictive value of fetal fibronectin sampling supports less intervention for patients with this result. |
| Databáze: | OpenAIRE |
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