Accuracy of fetal fibronectin for the prediction of preterm birth in symptomatic twin pregnancies: a pilot study

Florent Fuchs,Clémentine Lefevre,Hervé Fernandez,Marie-Victoire Senat

doi:10.1038/s41598-018-20447-5

Abstract

Our goal was to evaluate the performance of fetal fibronectin (fFN) test alone or combined with cervical length (CL), to predict spontaneous preterm birth (PTB) in symptomatic twin pregnancies. We carry out a short pilot study including all uncomplicated diamniotic twin pregnancies with symptoms of preterm labor (PTL) and intact membranes at 24–33 weeks + 6 days of gestation. Studied outcome were spontaneous delivery within 7 and 14 days of testing and spontaneous PTB at <34 and <37 weeks of gestation. Among 40 women, fFN test was positive in 3 of them (7.5%). Regardless of the outcome studied CL did not significantly predict PTB. Performance of fFN was sensitivity (66.7%), specificity (97.2%), positive predictive value (66.7%), negative predictive value (97.2%), positive likelihood ratio (LR) (24.0), and negative LR (0.3) to predict spontaneous PTB within 7 days (p = 0.01). Thus, 66.1% of patients with a positive fFN test would deliver within 7 days versus 2.4% if negative testing; starting with a pre-test probability of 7.5%. Combining CL and fFN did not enable to increase enough positive LR or decrease significantly negative LR. In conclusion, fFN test alone might have a better ability to detect spontaneous delivery within 7 days among symptomatic twin pregnancies.

Highlights

In high-income countries, incidence of preterm birth (PTB) keeps growing, and is affecting 11% of viable births[1]
In another meta-analysis, Conde–Agudelo and Romero found that fetal fibronectin (fFN) had only a limited accuracy in predicting PTB at
According to these results issued from heterogeneous studies, a positive fFN is associated with a 34% risk of PTB at

Summary

Introduction

In high-income countries, incidence of preterm birth (PTB) keeps growing, and is affecting 11% of viable births[1]. In a recent meta-analysis, the preterm delivery rate for twin pregnancies before 37, 34 and 32 weeks was 41, 13 and 7%, respectively[6] In such a high-risk population, predictive tests are mandatory, both in asymptomatic and in symptomatic population in order to appropriately time steroids administration[7]. A cervical length

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