Diagnostic accuracy of quantitative fetal fibronectin to predict spontaneous preterm birth: A meta-analysis.

Abstract

Use of quantitative fetal fibronectin (fFN) testing to predict spontaneous preterm birth (sPTB) is gaining attention owing to its absolute measurement of fFN concentration and increased positive predictive value compared with qualitative testing. To assess the predictive values of quantitative fFN for sPTB in different predefined thresholds using systematic review and meta-analysis. Five major databases (PubMed, ScienceDirect, Web of Science, Embase, Cochrane library) were searched for eligible studies. Observational studies of the diagnostic accuracy of different quantitative fFN thresholds on delivery outcomes were included. Articles were reviewed independently by two authors and data were extracted. Sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curves were extracted and calculated. Fifteen studies were included. To detect sPTB at less than 34weeks of gestation, pooled sensitivities for thresholds of 10, 50, 200, and 500ng/ml were 0.78, 0.56, 0.33, and 0.11, respectively. Pooled specificities were 0.63, 0.84, 0.96, and 0.99, respectively. Based on the results of the meta-analysis, the threshold of 10ng/ml fFN may be a new choice for the prediction of sPTB. The improved diagnostic accuracy of quantitative testing over qualitative testing can provide additional discriminatory information for clinical practice.