Fetal Fibronectin In Cervicovaginal Secretions Research Articles

Multiple ultrasonographic parameters and fetal fibronectin measurement for prediction of preterm labor at risk

Objective The present study was conducted to evaluate cervical length measurement, placental score, and amniotic fluid volume by ultrasound, and the level of fetal fibronectin (FFN) between 24 and 34 weeks of gestation as predictors of preterm labor. Background Spontaneous preterm birth continues to be the major contributor to perinatal morbidity and mortality. Early detection of preterm labor is difficult because initial symptoms and signs are often mild and may occur in normal pregnancy. The traditional criteria for preterm labor (persistent contractions accompanied by progressive cervical dilatation and effacement) are most accurate. Other means have been thought to detect preterm labor early. These include ultrasound examination of the cervix to measure the cervical length, measurement of amniotic fluid index, and detection of FFN in the cervicovaginal sample. Patients and methods This study was carried out on 80 pregnant women attending the antenatal care clinic of Kafr El-Dwar General Hospital from July 2014 to April 2015. The patients were divided into two groups: group one (50 cases), which included patients who have no history of unexplained preterm labor, and group two (30 cases), which included patients who have a history of unexplained preterm labor. Patients were followed up for the occurrence of preterm labor pain. Full complete history was taken from all cases, and then general examination was done for them. FFN testing and transabdominal and transvaginal ultrasound examination between 24 and 34 weeks of gestation with assessment of cervical length, fetal viability, number, fetal biometry (biparietal diameter, femur length, abdominal circumference), placenta (score, site, and maturity), and amniotic fluid (amount and turbidity) were performed. Results The results of this study revealed that the risk of preterm delivery (PTD) is inversely correlated with cervical length. Routine transvaginal scan of the cervix performed between 24 and 34 weeks helped to identify patients at risk of PTD; women with oligohydramnios are found to be liable to develop preterm labor. Assay of FFN in cervicovaginal secretions has proven to be a valuable test in the prediction of spontaneous PTD. Conclusion The first step in the prevention of preterm labor is early identification of women at risk for preterm birth by the use of ultrasonography to detect cervical length and amniotic fluid volume and by the detection of FFN in cervicovaginal secretion.

The clinical use of inflammatory markers during pregnancy

There is overwhelming evidence that intrauterine infection and inflammation play an important role in the pathogenesis of spontaneous preterm labor, preterm prelabor rupture of the membranes and fetal injury resulting in long-term sequelae. Early diagnosis of subclinical infection and inflammation may therefore aid clinicians institute interventions focusing on such adverse outcomes. Biomarkers of intrauterine inflammation such as interleukin-6, although sensitive, are not specific. Thus, decision to deliver remote from term because of intrauterine infection and/or inflammation should be based on clinical signs and/or bacterial culture or Gram stain of amniotic fluid. In patients with preterm contractions and intact membranes, the risk of delivery is 1% within the week following a negative fetal fibronectin in cervicovaginal secretions. This aids to decide whether antenatal steroids should be administered to patients presenting with preterm contractions between 24 and 34 weeks' gestation. Biomarkers in cervical secretions and amniotic fluid identify those who may benefit from cerclage when the cervix is shortened (<25 mm) and dilated in the second trimester. So far, few interventions utilizing inflammatory biomarkers have shown clinical benefit. Future efforts should focus on the quest for accurate biomarkers that can be obtained noninvasively and allow early prediction of subclinical disease to initiate appropriate risk-specific intervention.

Sonographic Measurement of Cervical Length ad Fetal Fibronectin Testing in Threatened Preterm Labor

When measured in women with preterm contractions, both the presence or absence of fetal fibronectin in cervicovaginal secretions and sonographically measured cervical length have been reported to distinguish true from false labor, essentially between women who will and will not deliver within the next 7 days. The present study, which prospectively enrolled 195 women with singleton pregnancies who were seen at 24 to 36 weeks gestation, attempted to determine whether combining these 2 tests is more predictive than either test by itself. Participants presented with regular painful uterine contractions but were less than 3 cm dilated and had intact membranes. Fetal fibronectin concentrations were measured by immunoassay in cervicovaginal secretions taken from the posterior fornix or endocervix followed by digital assessment of cervical dilation. Transvaginal sonography was then performed to measure cervical length. The clinician caring for each patient was blinded to the test results. The women presented at a median gestational age of 31 weeks; 19 of them (9.7%) delivered within 1 week. The rate of preterm delivery was 51.4% in women whose cervical length was less than 15 mm and 0.6% in those having a longer cervix. Similarly, the preterm delivery rate for women with positive fetal fibronectin was 21.2% compared with 0.9% for fibronectin-negative women. The positive and negative likelihood ratios for delivery within 1 week were 9.8 and 0.05, respectively, for a cervical length less than 15 mm, and 2.6 and 0.08 for a positive fibronectin test. The rate of delivery within 7 days increased exponentially as cervical length decreased. Cervical length correlated inversely with positive fetal fibronectin; the shorter the cervix, the more likely that fibronectin was positive. On multiple logistic regression analysis, the only factor that independently and significantly predicted preterm delivery was cervical length. Excluding cervical length, positive fibronectin contributed significantly to predicting delivery within 1 week. Other predictive factors included Afro-Caribbean ethnicity and gestational age at the time of presentation. Analysis of receiver-operating characteristic curves indicated that predictions based on cervical length were better than those provided by the fibronectin test. In women presenting with threatened preterm labor, a short cervix on sonography more accurately identifies those at high risk than does the presence of fetal fibronectin in cervicovaginal secretions. Measurements of cervical length can provide a basis for hospitalizing women and administering a tocolytic agent or steroid. If sonography is not available, risk status may be inferred from ethnic origin, gestational age, and the results of a fetal fibronectin test.

Sonographic measurement of cervical length and fetal fibronectin testing in threatened preterm labor

In women presenting with threatened preterm labor, both fetal fibronectin and sonographic measurement of cervical length have been shown to distinguish between true and false labor. The aim of this study was to determine whether the combination of both tests provides a better prediction than the individual tests alone. We examined 195 women with singleton pregnancies presenting at 24-36 (median 31) weeks of gestation with regular and painful uterine contractions, intact membranes and cervical dilatation of less than 3 cm. On admission to the hospital fetal fibronectin positivity in cervicovaginal secretions was determined and transvaginal sonographic measurement of cervical length was carried out. The results were not made available to the attending obstetrician. The primary outcome measure was delivery within 7 days of presentation. Delivery within 7 days occurred in 51.4% (18 of 35) of those with cervical length below 15 mm and 0.6% (1 of 160) of those with cervical length of 15 mm or more, in 21.2% (18 of 85) of the fibronectin positive group and in 0.9% (1 of 110) of the fibronectin negative group. There was a significant association between cervical length and the incidence of fibronectin positivity (r = -0.921, P = 0.003). Logistic regression analysis demonstrated that the only significant contributor to the prediction of delivery within 7 days was cervical length, with no significant contribution from fibronectin positivity, ethnic origin, maternal age, gestational age, body mass index, parity, previous history of preterm delivery, cigarette smoking, or use of tocolytics. In women with threatened preterm labor assessment of fetal fibronectin in cervicovaginal secretions does not improve the prediction of delivery within 7 days provided by the sonographic measurement of cervical length.

Fetal fibronectin as predictor of successful induction of mid‐trimester abortion

Fetal fibronectin (FFN) in cervical secretion is one of the most effective markers of pre-term and term delivery. The presence of FFN in cervicovaginal secretions has recently been shown to reflect cervical state and an uncomplicated induction of labor at term. This study was designed to determine whether FFN could be a biochemical marker to predict the response to prostaglandins in early mid-trimester abortion. The presence of cervical FFN was evaluated by means of qualitative rapid immunoassay in 270 patients, who required second trimester termination of pregnancy at the Department of Gynecology and Obstetrics, University of Naples 'Federico II'. According to the standard protocol of our unit, women received 1.0 mg of gemeprost intravaginally at 3-hr intervals up to a maximum of five suppositories. The induction-to-abortion interval and the percentage of successful abortions within 24 hr in women in the positive FFN group (n=19) were compared with those in the negative FFN group (n=251). FFN in the cervical secretions was present in seven women (10.2%) at 16-weeks gestation, in seven women (7.5%) at 17-weeks gestation, and in five women (4.5%) at 18-week gestation. Final termination rates were 13 (68.4%) in the fibronectin-positive group and 177 (70.5%) in the fibronectin-negative group. The median abortion interval was similar (14.7 versus 15.1 hr) in both groups. A positive cervical fetal fibronectin test does not predict a successful medical termination of pregnancy in second trimester abortion. In this setting, the role of fetal cervical fibronectin in cervical ripening is, therefore, questionable.

Cervicovaginal fetal fibronectin levels in women with preeclampsia

OBJECTIVE:To estimate the mean levels of fetal fibronectin in cervicovaginal secretions of women with preeclampsia and compare them with levels in normotensive controls.METHODS:Cervicovaginal swabs were obtained before digital examination from women who presented to labor and delivery for evaluation of preeclampsia and compared with fetal fibronectin levels from a group of control subjects with a similar gestational age. Fetal fibronectin was assayed by a specific enzyme-linked immunoassay. A concentration greater than 50 ng/mL was considered a positive result.RESULTS:Forty women with preeclampsia (17 mild and 23 severe) and 31 normotensive women were analyzed. The control group had 9.7% positive fetal fibronectins, whereas the preeclampsia group had 15% positive, P = .72, with 80% power to detect a 22% difference. The majority of the quantitative values in both groups were less than 20 ng/mL. There was not a significant difference between the two groups in quantitative cervicovaginal fetal fibronectin, P = .72, nor was there a difference between the women with severe preeclampsia and the controls, P = 1.0, or between the nulliparous women with preeclampsia versus the nulliparous controls, P = .3.CONCLUSION:Fetal fibronectin is not elevated in cervicovaginal secretions of women with preeclampsia.

Prediction of Cervical Response to Prostaglandin E2 Using Fetal Fibronectin

Fetal fibronectin (FFN), a special form of the glycoprotein present in amniotic fluid and at the chorio-decidual interface, may be distinguished from adult fibronectin using monoclonal antibody FCD-6. Levels of the fetal form reportedly correlate strongly with the Bishop score, with positive fibronectin found more often where there is a favorable cervix. This study was an attempt to determine whether the presence of FFN in cervicovaginal secretions at term predicts the cervical response to prostaglandin E2 (PGE2) pessaries and successful induction of labor when the cervix is unfavorable. Secretions were tested before cervical ripening was attempted with PGE2 pessaries in 58 women with a singleton term or postterm pregnancy and a modified Bishop score less than 5 who were undergoing induction. Vaginal pessaries containing 3 mg of Prostin E2 were used. FFN was estimated by means of a solid-phase immunoassay using an anti-human fibronectin-gold colloid conjugate and FCD-6. Nineteen of the 58 women in the study (32 percent) had a positive result on the immunoassay for FFN. All but two of them had a modified Bishop score of 5 or greater or entered labor within 4 to 6 hours after vaginal placement of a single pessary. Two women required a second pessary but underwent cesarean delivery, one because of failed induction and the other because of failure to progress. Nearly half of the FFN-negative subjects had an improved Bishop score or entered labor after a single PGE2 pessary. Seven of the other 20 women delivered vaginally after a second dose. Eight women received a third or fourth pessary, and five of them delivered vaginally. Five women received oxytocin and had the membranes ruptured, but only one of them delivered vaginally. FFN-negative women required more PGE2 and had longer induction-delivery intervals than FFN-positive women, but there was no significant difference in the length of the active phase of labor. Fewer operative deliveries were performed in the FFN-positive group, but this trend was not statistically significant. These findings suggest that the FFN assay be part of assessing cervical status when labor is to be induced. Acta Obstet Gynecol Scand 1999;79:861–865

Prostaglandin endoperoxide H synthase mRNA expression in the fetal membranes correlates with fetal fibronectin concentration in the cervico-vaginal fluids at term: evidence of enzyme induction before the onset of labour.

To determine the relationship of prostaglandin endoperoxide H synthase (PGHS) expression in the gestational tissues and fetal fibronectin in cervico-vaginal fluids before the onset of labour at term. Cross-sectional, observational study. Amnion, chorion laeve and decidua were collected from 24 term pregnant women following elective caesarean section. Samples of cervico-vaginal secretions were obtained from the same women immediately before caesarean section. PGHS-1 and PGHS-2 mRNA levels in tissues were determined by specific ribonuclease protection assays. Fetal fibronectin concentrations in the cervico-vaginal fluids were measured by enzyme-linked immunosorbent assay. The abundance of PGHS mRNA was compared between groups of patients with the same mean gestational age but different cervico-vaginal fetal fibronectin levels. Linear regression analysis was used to determine the association between PGHS levels and fetal fibronectin. Two groups of women were identified who had significantly different fetal fibronectin values but the same gestational ages. The group with the higher fetal fibronectin concentrations had significantly higher PGHS- 1 and PGHS-2 mRNA levels in the chorion laeve and higher PGHS-2 mRNA levels in the amnion, than the group with lower fetal fibronectin concentrations. PGHS- 1 and PGHS-2 mRNA levels in the chorion laeve and PGHS-2 mRNA in the amnion showed an overall significant association with fetal fibronectin levels. High concentrations of fetal fibronectin in cervico-vaginal secretions before the onset of spontaneous labour at term are associated with high levels of PGHS-2 mRNA in the chorion laeve and the amnion and of PGHS- 1 mRNA in the chorion laeve. Increased expression of PGHS in these tissues may therefore be involved in the events leading to term birth.

Fetal fibronectin as a predictor of term labor: A literature review

Accurately predicting the onset of delivery continues to be problematic notwithstanding the clinical relevance of this capability, especially with regard to the elective induction of labor. While the assessment of the cervix according to Bishop, to date, constitutes the single generally recognized method, the determination of fetal fibronectin (FFN) cervicovaginal secretions promises greater precision in this context.English-language medical literature was analyzed using the search parameter 'fetal fibronectin', 'term delivery', 'induction of labor', 'labor', and 'birth', respectively. All those original reports examining cervicovaginal FFN that were originally published in English and followed a prospective design were subsequently included in the study at hand. These reports were evaluated in regard to their findings on the predictive value of FFN for spontaneous delivery and induction of labor.A total of eight reports were included in the present study: five of these, covering a total of 480 patients, discussed the relationship between FFN and the spontaneous onset of labor; the other three addressed the subject of FFN and the induction of labor (300 patients). All reports clearly related the presence of FFN in cervicovaginal secretions to the imminent onset of delivery; three studies, furthermore, demonstrated a correlation with the spontaneous onset of labor, with a sensitivity greater than 90%. In case of the studies concerning induction of labor, a positive FFN result was accompanied by a significantly shorter interval until delivery than a negative FFN result.Determining the presence of FFN in cervicovaginal secretions promises to provide an indicator relating to the prediction of term labor, as well as to the prediction of successful labor induction.

Fetal fibronectin as a predictor of term labor:

Accurately predicting the onset of delivery continues to be problematic notwithstanding the clinical relevance of this capability, especially with regard to the elective induction of labor. While the assessment of the cervix according to Bishop, to date, constitutes the single generally recognized method, the determination of fetal fibronectin (FFN) cervicovaginal secretions promises greater precision in this context. English-language medical literature was analyzed using the search parameter 'fetal fibronectin', 'term delivery', 'induction of labor', 'labor', and 'birth', respectively. All those original reports examining cervicovaginal FFN that were originally published in English and followed a prospective design were subsequently included in the study at hand. These reports were evaluated in regard to their findings on the predictive value of FFN for spontaneous delivery and induction of labor. A total of eight reports were included in the present study: five of these, covering a total of 480 patients, discussed the relationship between FFN and the spontaneous onset of labor; the other three addressed the subject of FFN and the induction of labor (300 patients). All reports clearly related the presence of FFN in cervicovaginal secretions to the imminent onset of delivery; three studies, furthermore, demonstrated a correlation with the spontaneous onset of labor, with a sensitivity greater than 90%. In case of the studies concerning induction of labor, a positive FFN result was accompanied by a significantly shorter interval until delivery than a negative FFN result. Determining the presence of FFN in cervicovaginal secretions promises to provide an indicator relating to the prediction of term labor, as well as to the prediction of successful labor induction.

Prediction of cervical response to prostaglandin E2 using fetal fibronectin

To determine whether presence of fetal fibronectin in cervico-vaginal secretions at term will predict the cervical response to prostaglandin E2 (PGE2) pessaries and successful induction of labor amongst subjects with unfavorable cervices. Cervico-vaginal secretion was tested for the presence of fetal fibronectin prior to cervical ripening with PGE2 pessaries in women with a singleton term or post-term pregnancy undergoing induction of labor. The total number of PGE2 pessaries, interval from induction to labor and induction to delivery, latent phase and active phase of labor and cesarean section rate were compared. Women with fetal fibronectin in their cervico-vaginal secretion had better cervical response to PGE2 pessaries and required fewer doses for induction of labor and they took a shorter time interval from induction to delivery. They tend to have a lower cesarean section rate but the figures did not reach statistical significance. The presence of fetal fibronectin from cervico-vaginal secretions in subjects with a Bishop score <5 is predictive of a favorable response to induction by prostaglandin pessary

PREDICTION OF PRETERM DELIVERY BY FETAL FIBRONECTIN

Objective To assess the cervicovaginal fetal fibronectin test to predict preterm delivery. Data Sources We searched MEDLINE, Current Contents, Index Medicus, and proceedings of meetings for studies published between 1991 and June 1997. Methods of Study Selection Inclusion criteria were prospective cohort study; test performed between 20 and 36 weeks' gestation; fetal fibronectin measured by a previously described assay, with a cutoff level set at 50 ng/mL; test results not disclosed to women or physicians; and fewer than 20% of study participants excluded from the analysis. Tabulation, Integration, and Results Twenty-nine relevant studies were stratified according to the prevalence of pre-term delivery, the number of tests performed, and delivery before 34, 35, or 37 weeks. Sensitivities, specificities, and likelihood ratios were calculated in each study. The sum-mary estimates of the likelihood ratio for tests yielding positive results or tests yielding negative results along with their 95% confidence intervals (CIs) were computed in each stratum according to a random-effects model. All summary likelihood ratios for a test yielding positive results indicated a significant association with preterm delivery. The strongest association was found between a single test with positive results and delivery before 37 weeks in a low-risk population (likelihood ratio 7.5; 95% CI 4.6, 12.3). This association also was found in high-risk women (likelihood ratio 3.5; 95% CI 2.6, 4.6). In high-risk women, a test yielding negative results was associated with a reduction in risk of preterm delivery (likelihood ratio 0.4; 95% CI 0.3, 0.5). Conclusion Fetal fibronectin in cervicovaginal secretions is associated with preterm delivery in both high-risk and low-risk women.

Effect of sexual intercourse on fetal fibronectin concentration in cervicovaginal secretions

An investigation was performed evaluating persistence of fetal fibronectin in cervicovaginal secretions after sexual intercourse. Fetal fibronectin samples were positive at 12 to 24 hours, 24 to 48 hours, and 48 to 72 hours after coitus in 22.2%, 11.8%, and 5.6% of samples, respectively. A history of vaginal intercourse should be obtained before sampling for fetal fibronectin to eliminate this potential source of false-positive fibronectin test. (Am J Obstet Gynecol 1998;179:255-6.)

Rapid fetal fibronectin swab-test in preterm labor patients treated by betamimetics

Objective: A preliminary study to examine the value of a rapid fetal fibronectin swab-test used as a bedside test in the prognosis of preterm labor. Study design: Women presenting with preterm labor and intact membranes and less than 3 cm dilated were enrolled in a single referal center. Cervicovaginal swabs were assessed for the presence or absence of fetal fibronectin by means of a rapid monoclonal antibody assay the positivity of which was revealed by a colorimetric reaction. Results were compared with uterine contractions frequency, Bishop cervical score, duration of tocolysis and interval to delivery. The predictive value of fetal fibronectin test for delivery within 7, 14 or 21 days from sampling and before 32 and 37 weeks' of gestation was assessed in the two groups. Results: Among 124 eligible patients, 19 presented with a positive fibronectin test and 105 with a negative one. Gestational age at sampling. Bishop cervical score and duration of tocolysis were identical in the two groups. The number of contractions was significantly lower and gestational age at delivery was significantly higher in the fibronectin negative group. Fetal fibronectin in cervicovaginal secretions has a high sensitivity (89%) for delivery within 7 days. Absence of fetal fibronectin in cervicovaginal secretions of patients presenting with uterine contractions could rule out preterm labor within 7 and 14 days with a predictive value of 99 and 95.2%, respectively. In negative fetal fibronectin patients, preterm delivery before 32 and 37 weeks' is unlikely to occur with a predictive value of 97 and 85%, respectively. Conclusion: Cervicovaginal fetal fibronectin detected by a rapid bedside swab-test in women with symptoms of preterm labor compares favourably with quantitative assays and could prove useful in the management of preterm labor. This should be confirmed in a longer prospective study.

Cervico‐vaginal fetal fibronectin: Predictive value during false labor

The purpose was to determine to what extent fetal fibronectin was a discriminative test of preterm delivery in patients hospitalized for uterine contractions without modification of the cervix. The prospective double-blind study included patients hospitalized between 24 and 34 week for false labor. Cervicovaginal swabs were obtained and assayed for the presence of fetal fibronectin by means of a monoclonal antibody assay. Out of the 61 patients included, 18 showed a positive swab. The correlation of a positive result with preterm delivery revealed a sensitivity of 56%, a specificity of 81%, and positive and negative predictive values of 56% and 81% respectively. Meta-analysis of studies published shows that the presence of fibronectin represents a significant relative risk of 3.3 (IC: 2.5-42) of preterm delivery. The presence of fetal fibronectin in cervicovaginal secretions of patients presenting with false labor indicates a major risk of preterm delivery.

Review Article: Cervico-vaginal fetal fibronectin: Predictive value during false labor

Objective. The purpose was to determine to what extent fetal fibronectin was a discriminative tesl of preterm delivery in patients hospitalized for uterine contractions without modification of I he cervix. Study design. The prospective double-blind study included patients hospitalized between 24 and 34 weeks for false labor. Cervicovaginal swabs were obtained and assayed for the presence of fetal fibronectin by means of a monoclonal antibody assay. Results. Out of the 61 patients included, 18 showed a positive swab. The correlation of a positive result with preterm delivery revealed a sensitivity of 56%, a specificity of 81%, and positive and negative predictive values of 56% and 81% respectively. Meta-analysis of studies published shows that the presence of fibronectin represents a significant relative risk of 3.3 (IC: 2.5–42) of preterm delivery. Conclusion. The presence of fetal fibronectin in cervicovaginal secretions of patients presenting with false labor indicates a major risk of preterm delivery.

Fetal fibronectin in cervicovaginal secretions as a predictor of preterm birth

To determine whether fetal fibronectin detected in cervicovaginal secretions of patients with symptoms suggestive of preterm labour is a predictor for preterm birth. A blind prospective observational study. A teaching hospital. One hundred and forty-one women presenting to the delivery suite between 24 and 37 weeks of gestation (112 were between 24 and 34 weeks of gestation) with symptoms suggestive of preterm labour, with intact membranes and cervical dilation of < 2 cm. Specimens of cervicovaginal secretions were collected from the ectocervix and posterior fornix. Fetal fibronectin levels were measured by an ELISA and samples were considered positive if the level of fetal fibronectin present was > or = 0.05 microgram/ml. Gestation at birth and sampling-birth interval. The preterm birth (before 37 weeks of gestation) rate in the population studied was 19.1%. Fetal fibronectin predicted preterm birth with sensitivity of 63%, specificity of 95.6%, positive predictive value of 77.3%, and negative predictive value of 91.6%. Analysis of the data from women at less than 34 weeks of gestation showed similar results. A negative test accurately excluded (97.9%) the chance of subsequent birth during the three weeks interval following sampling. The presence of fetal fibronectin in the cervicovaginal secretions of women admitted with symptoms suggestive of preterm labour indicates a significant risk for subsequent preterm birth. The absence of fetal fibronectin in this group is a very strong indication that subsequent preterm birth is unlikely to occur. Fetal fibronectin test, if combined with clinical findings, has a potentially important role in clinical management of women with symptoms suggestive of preterm labour.

The presence of fetal fibronectin in the cervicovaginal secretions of women at term - Its role in the assessment of women before labor induction and in the investigation of the physiologic mechanisms of labor

OBJECTIVE: Our purpose was to determine whether the presence of fetal fibronectin in cervicovaginal secretions of patients undergoing induction of labor reflected the cervical state and ultimately the ease of induction of labor. STUDY DESIGN: A prospective observational study of 103 patients undergoing induction of labor at term was conducted at Liverpool Maternity Hospital, a large university teaching hospital. We studied the women after 37 completed weeks of pregnancy. A Dacron (Adeza Biomedical, Sunnyvale, Calif.) polyester swab specimen was first taken from the endocervix for assessment of the presence of the fetal fibronectin. The cervix was then assessed by digital vaginal examination and scored with a modified Bishop's score. The fetal fibronectin swab was processed at the bedside with a membrane immunoassay kit specific for fetal fibronectin. A score was ascribed depending on the strength of the fibronectin reaction determined by the intensity of the color change on the plate, the presence of fetal fibronectin resulting in a score of 1 to 4. The patient was subsequently managed according to the standard induction protocol of the unit. The clinicians involved in the patient's care were blind to the result of the fetal fibronectin swab. RESULTS: There was a good correlation between the modified Bishop's score and the fetal fibronectin score ( r = 0.58, p < 0.001). To predict a latent phase of <8 hours, a fetal fibronectin score of 3 or 4 has a sensitivity of 73% with a specificity of 83% and a modified Bishop score of ≥4 has a sensitivity of 75% and a specificity of 73%. For delivery within 12 hours of induction of labor a fetal fibronectin score of ≥3 has a sensitivity of 61% and specificity of 83% compared with the modified Bishop score of ≥4, which has a sensitivity of 76% and a specificity of 72.5%. CONCLUSIONS: The fetal fibronectin score is as good as the modified Bishop score as an index of the ease with which induction of labor may be performed. This would imply that it also reflects the proximity of the onset of labor. The presence of fetal fibronectinin cervicovaginal secretions is therefore a marker of the changes in the cervix and membranes that precede labor regardless of the gestational age. (A M J O BSTET G YNECOL 1996;174:262-6.)

Fetal fibronectin as a selection criterion for induction of term labor

OBJECTIVE: We examined whether the presence of fetal fibronectin in cervicovaginal secretions can be used as a selection criterion for induction of labor at term. STUDY DESIGN: Cervicovaginal secretions of 64 women who were scheduled for induction of labor were examined for fetal fibronectin and divided into group A (positive for fibronectin) and group B (negative for fibronectin). Both groups were examined for Bishop score, the number of prostaglandin tablets administered, and the interval between induction of labor and delivery. RESULTS: In group A the interval between induction of labor and delivery was significantly shorter ( p < 0.0001) than in group B. The number of prostaglandin tablets administered to group A was likewise significantly lower ( p < 0.0001). Unsuccessful induction of labor only occurred in women with fibronectin-negative cervicovaginal secretions. CONCLUSION: The assessment of the fibronectin content of cervicovaginal secretions constitutes a viable instrument in the decision-making process preceding induction of labor.

Fetal fibronectin as a marker to predict the onset of term labor and delivery

OBJECTIVE: We examined whether the presence of fetal fibronectin in cervicovaginal secretions may be a marker to predict the onset of term labor and delivery. STUDY DESIGN: A prospective study was performed in 100 primiparous and multiparous women having reached their expected date of confinement. Fetal fibronectin was assayed by taking samples of both the cervical and vaginal mucus with two different fetal fibronectin tests. The study population was divided into women delivering within 48 hours and women giving birth >48 hours after sampling. RESULTS: Seven patients had to be excluded from evaluation. Of the remaining 93 women, 37 were delivered within 48 hours; fetal fibronectin was detected in 30. Fifty-six women were delivered later than 48 hours; 51 of them had negative results for fetal fibronectin (positive accuracy 86%, negative accuracy 88%, p < 0.0001). CONCLUSION: Fetal fibronectin in the cervicovaginal secretions of women who have reached their expected date of confinement is a useful predictor of the onset of term labor and delivery.