Fetal Fibronectin Research Articles

Developing a logistic regression model to predict spontaneous preterm birth from maternal socio-demographic and obstetric history at initial pregnancy registration

BackgroundCurrent predictive machine learning techniques for spontaneous preterm birth heavily rely on a history of previous preterm birth and/or costly techniques such as fetal fibronectin and ultrasound measurement of cervical length to the disadvantage of those considered at low risk and/or those who have no access to more expensive screening tools.Aims and objectivesWe aimed to develop a predictive model for spontaneous preterm delivery < 37 weeks using socio-demographic and clinical data readily available at booking -an approach which could be suitable for all women regardless of their previous obstetric history.MethodsWe developed a logistic regression model using seven feature variables derived from maternal socio-demographic and obstetric history from a preterm birth (n = 917) and a matched full-term (n = 100) cohort in 2018 and 2020 at a tertiary obstetric unit in the UK. A three-fold cross-validation technique was applied with subsets for data training and testing in Python® (version 3.8) using the most predictive factors. The model performance was then compared to the previously published predictive algorithms.ResultsThe retrospective model showed good predictive accuracy with an AUC of 0.76 (95% CI: 0.71–0.83) for spontaneous preterm birth, with a sensitivity and specificity of 0.71 (95% CI: 0.66–0.76) and 0.78 (95% CI: 0.63–0.88) respectively based on seven variables: maternal age, BMI, ethnicity, smoking, gestational type, substance misuse and parity/obstetric history.ConclusionPending further validation, our observations suggest that key maternal demographic features, incorporated into a traditional mathematical model, have promising predictive utility for spontaneous preterm birth in pregnant women in our region without the need for cervical length and/or fetal fibronectin.

Prediction of preterm birth in multiparous women using logistic regression and machine learning approaches

To predict preterm birth (PTB) in multiparous women, comparing machine learning approaches with traditional logistic regression. A population-based cohort study was conducted using data from the Ontario Better Outcomes Registry and Network (BORN). The cohort included all multiparous women who delivered a singleton birth at 20–42 weeks’ gestation in an Ontario hospital between April 1, 2012 and March 31, 2014. The primary outcome was PTB < 37 weeks, with spontaneous PTB analyzed as a secondary outcome. Stepwise logistic regression and the Boruta machine learning were used to select the important variables during the first and second trimester. For building prediction models, the whole data set were divided for the two independent parts: two-third for training the classifiers (Logistic regression, random forests, decision trees, and artificial neural networks) and one-third for model validation. Then, the training data set were balanced by random over sampling technique. The best hyper parameters were obtained by the tenfold cross validation. The performance of all models was evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristics (AUC). The cohort included 145,846 births, of which 8125 (5.57%) were preterm. In first-trimester models, the strongest predictors of PTB were previous PTB, preexisting diabetes, and abnormal pregnancy‐associated plasma protein-A. In the testing data set, the highest predictive ability was seen for artificial neural networks, with an area under the receiver operating characteristic curve (AUC) of 68.8% (95% CI 67.6–70.1%). In second-trimester models, addition of infant sex, attendance at first-trimester appointment, medication exposure, and abnormal alpha-fetoprotein concentrations increased the AUC to 72.1% (95% CI 71.1–73.1%) with logistic regression. With the inclusion of the variable complications during pregnancy, the AUC increased to 80.5% (95% CI 79.6–81.5%) using logistic regression. For both overall and spontaneous PTB, during both the first and second trimesters, models yielded negative predictive values of 97%. Overall, machine learning and logistic regression produced similar performance for prediction of PTB. For overall and spontaneous PTB, both first- and second-trimester models provided negative predictive values of ~ 97%, higher than that of fetal fibronectin.

Quantitative cervicovaginal fluid fetal fibronectin: A liquid biopsy for intra-amniotic inflammation.

Intra-amniotic inflammation is causally linked to spontaneous preterm labor. The gold standard for the diagnosis of intra-amniotic inflammation is the determination of an amniotic fluid profile obtained from transabdominal amniocentesis, which is invasive. Cervicovaginal fluid fetal fibronectin (fFN) is a widely-used predictive biomarker for spontaneous preterm labor. The aims of this study are to determine (1) whether a quantitative cervicovaginal fluid fFN test can be used to identify the presence of intra-amniotic inflammation; and (2) an appropriate cut-off value of a cervicovaginal fluid fFN concentration for the identification of intra-amniotic inflammation. This prospective cohort study included 78 patients with preterm labor and intact membranes who had a sample collected for quantitative cervicovaginal fluid fFN measurement and underwent transabdominal amniocentesis. Intra-amniotic inflammation was defined as an amniotic fluid interleukin-6 concentration ≥2.6 ng/mL. Clinicians were masked from the results of cervicovaginal fluid fFN and amniotic fluid interleukin-6 concentrations. Logistic regression analysis was used to determine which factors were significant predictors of intra-amniotic inflammation. The diagnostic indices of the cervicovaginal fluid fFN test for the identification of intra-amniotic inflammation were calculated. (1) Frequency of intra-amniotic inflammation was 26.9% (21/78); (2) the higher the cervicovaginal fluid fFN concentration, the greater the risk of intra-amniotic inflammation (p < 0.001); (3) cervicovaginal fluid fFN concentration ≥125 ng/mL had an area under the curve of 0.91 (95% confidence interval: 0.83-0.96) for the identification of intra-amniotic inflammation with 100% sensitivity, 100% negative predictive value, 82.46% specificity and a positive likelihood ratio of 5.7; and (4) cervicovaginal fluid fFN cut-off of 125 ng/mL had a significant higher predictive performance than the traditional cut-off (50 ng/mL) for the identification of intra-amniotic inflammation. Quantitative cervicovaginal fluid fFN with a cut-off of 125 ng/mL had a high sensitivity and a negative predictive value as well as a positive likelihood ratio for the identification of intra-amniotic inflammation. Its high sensitivity and negative predictive value can be used to decrease an index of suspicion of intra-amniotic inflammation. This test may be useful as an initial assessment test to select appropriate patients for amniocentesis to determine intra-amniotic inflammation.

Cervicovaginal foetal fibronectin in predicting success of induced labour among nulliparous women: a systematic review

Background The global rates of labor induction continue to exhibit a surge, attributed to a range of medical, obstetric, and non-medical factors. Although the Bishop score is often used to assess cervical preparation, its ability to accurately predict outcomes, particularly in nulliparous women with an unfavorable cervix, is still unknown. Method A complete review of the literature was undertaken, including PubMed, EMBASE, Cochrane Library, and Google Scholar databases, with the search period extending until April 2023. The studies included in this analysis focused on investigating the predictive value of fFN concerning induced labor outcomes in nulliparous women. The process of data extraction primarily concentrated on the features of the study, interventions, controls, criteria for inclusion and exclusion, and the outcomes that were evaluated. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Results The review synthesized findings from five studies, revealing varied predictive values of fFN. Sciscione et al. (2005) reported no significant difference in vaginal delivery rates between positive and negative fFN groups (Positive fFN: 55.8% vs. Negative fFN: 53.3%; P &gt; .70). Uygur et al. (2016) found a higher cesarean section rate in patients with negative fFN results (P = 0.002). Reis et al. (2003) highlighted that higher parity and Bishop scores were more predictive than fFN alone (P = .021 for funneling; P = .157 for fFN presence). Grab et al. (2022) and Khalaf et al. (2023) further corroborated fFN's role in predicting labor outcomes, with the latter study demonstrating high sensitivity (85%), specificity (80%), and accuracy (82.6%) in predicting successful labor induction (P &lt; .05 for Bishop score relation with fFN; P = 0.029 for positive vs. negative fFN). Conclusion This systematic review validated that fFN is a significant biomarker for predicting labor induction outcomes, especially in nulliparous women. The combination of additional clinical factors with fFN has been shown to boost its prediction accuracy, indicating the need for a personalized strategy to labor induction.

The association of matrix metalloproteinase-9 and fetal fibronectin in the first trimester threatened miscarriage

The association of matrix metalloproteinase-9 and fetal fibronectin in the first trimester threatened miscarriage

Vasa Previa and the Role of Fetal Fibronectin and Cervical Length Surveillance: A Review.

Vasa previa is a pregnancy complication that occurs when unprotected fetal blood vessels traverse the cervical os, placing the fetus at high risk of exsanguination and fetal death. These fetal vessels may be compromised by fetal movement and compression, leading to poor oxygen distribution and asphyxiation. Diagnostic tools for vasa previa management and preterm labor (PTL) include transvaginal ultrasound, cervical length (CL) surveillance and use of fetal fibronectin (FFN) testing. These tools can prove to be quite useful as they allow for lead time in the prediction of PTL and spontaneous rupture of membranes which can result in devastating outcomes for pregnancies affected by vasa previa. We conducted a literature review on vasa previa management and the usefulness of FFN and CL surveillance in predicting PTL and found 36 related papers. Although there is limited research available to show the impact of FFN and CL surveillance in the management of vasa previa, there is sufficient evidence to support FFN and CL surveillance in predicting the onset of PTL, which can have devastating consequences for the pregnancies affected. It can be extrapolated that these tools, by helping to determine pregnancies at risk for PTL, could improve management and outcomes in patients with vasa previa. Future studies investigating the management of vasa previa with FFN and CL surveillance to reduce the burden of PTL and its associated comorbidities are warranted.

Management, Utilization, and Outcomes of Preterm Labor in an Integrated Health Care System.

Fetal fibronectin (fFN) testing and transvaginal ultrasound (TVUS) are diagnostic tools used to predict impending spontaneous preterm birth (sPTB) among women presenting with preterm labor (PTL). We evaluated the association between fFN testing or TVUS cervical length (CL) measurement in predicting sPTB, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) admission, and sPTB-related costs. We conducted a retrospective cohort study using data from the Kaiser Permanente Southern California electronic health system (January 1, 2009-December 31, 2020) using diagnostic and procedure codes, along with a natural language processing algorithm to identify pregnancies with PTL evaluations. PTL evaluation was defined as having fFN and/or TVUS assessment. Outcomes were ascertained using diagnostic, procedural, and diagnosis-related group codes. Multivariable logistic regression assessed the association between fFN and/or TVUS results and perinatal outcomes. Compared with those without PTL evaluations, those with positive fFN tests had higher adjusted odds ratio (adj.OR) for sPTB (2.95, 95% confidence interval [CI]: 2.64, 3.29), RDS (2.34, 95% CI: 2.03, 2.69), and NICU admission (2.24, 95% CI: 2.01, 2.50). In contrast, those who tested negative had lower odds for sPTB (adj.OR: 0.75, 95% CI: 0.70, 0.79), RDS (adj.OR: 0.67, 95% CI: 0.61, 0.73), and NICU admission (adj.OR: 0.74, 95% CI: 0.70, 0.79). Among those with positive fFN results, the odds of sPTB was inversely associated with CL. Health care costs for mothers and neonates were lowest for those with fFN testing only. This study demonstrates that positive fFN results were associated with an increased odds of sPTB, RDS, and NICU admission and the association with sPTB was inversely proportional to CL. Additionally, negative fFN results were associated with decreased odds of sPTB, RDS, and NICU admissions. fFN testing may predict these and other sPTB-related adverse outcomes hence its utility should be explored further. Moreover, fFN testing has some cost savings over TVUS. · Patients with positive fFN tests had higher odds of sPTB, RDS, and NICU admission.. · Inverse relationship between sPTB and CL among those with positive fFN tests was observed.. · Health care costs for mothers and neonates were lowest for those with fFN testing only..

DIFFERENCES OF FIBRONECTIN LEVELS IN FIRST TRIMESTER NORMAL PREGNANCY AND MISCARRIAGE

Introduction: Miscarriage is a reflection of the low quality of health in pregnant women. The incidence of miscarriage in the world accounts for 23 million (15%) of the 130 million births per year and up to 80% of miscarriages occur in the first trimester of pregnancy. Miscarriage will affect a woman's social, physical, and psychological. The complexity of the negative impact of miscarriage makes it necessary to pay special attention. Biomarker examination is needed to more accurately identify pregnancies at risk of miscarriage before the appearance of clinical symptoms. The use of fetal fibronectin (fFN) levels have been used as a marker of unexpected labor and as evidence of premature rupture of the fetal membranes. Normally fFN can be detected in cervical and vaginal secretions at &lt;20 weeks gestation. The presence of fFN at &gt;22 weeks gestation indicates disruption of the uteroplacental surface. Therefore, if screening for fibronectin levels using the Enzyme-Linked Immunosorbent Assay (ELISA) test can be carried out in the first trimester of pregnancy, there is a high possibility that miscarriage can be prevented.Method: The type of research is analytical observational research with a cross-sectional research design. The stored samples were examined for fibronectin levels using the ELISA test, which included 21 blood serum samples from normal pregnancy patients in the first trimester and 21 miscarriage samples.Results: The results of the ELISA test produced an average first-trimester normal pregnancy fibronectin level of 118.8 ± 18.4 ng/mL while the miscarriage fibronectin level was 208.2 ± 152.0 ng/mL. Data analysis using the Mann-Whitney test obtained a p-value = 0.138, which means there was no significant difference in fibronectin levels between normal pregnancy in the first trimester and miscarriage.Conclusion: This study concludes that fibronectin levels are not specific biomarkers in detecting miscarriage in the first trimester of pregnancy.

Preterm Birth: A Review of Its Early Diagnosis and Prevention

Preterm birth, a major global healthcare concern, is characterized by infants being born before completing 37 weeks of gestation. Accurate diagnosis and effective interventions are critical to managing this complex issue. This abstract provides an overview of the diagnosis and prevention of preterm birth, focusing on risk assessment, diagnostic techniques, and various interventions for mothers and newborns. The diagnostic process involves evaluating risk factors, clinical history, and the assessment of potential membrane rupture. Techniques such as speculum examination, the Nitrazine test, the Fern test, ultrasonography, and the Placental Alpha Microglobulin-1 test play vital roles in identifying membrane rupture and infection. Additional diagnostic markers include cervical ultrasonography and fetal fibronectin testing. Prevention strategies include lifestyle changes, maternal therapies, and antenatal interventions. Smoking cessation programs, low-dose aspirin, antenatal corticosteroid therapy, progesterone supplementation, magnesium sulfate, and antibiotic treatment are employed to reduce the risk of preterm birth. Cervical cerclage, another surgical intervention, is recommended in specific cases.&#x0D; For preterm newborns, immediate and effective care is vital. This includes thermal care, early breastfeeding, infection prevention, and respiratory distress syndrome management. These interventions are crucial in reducing infant mortality and morbidity associated with preterm birth. Efforts to diagnose and prevent preterm birth are essential in improving the well-being of both mothers and their newborns. A comprehensive approach, combining accurate diagnosis and effective interventions, can make a significant impact in reducing the burden of preterm birth on healthcare systems and families.&#x0D; Keywords: Preterm birth, infants, gestation, potential membrane rupture

Predicting preterm birth within 2 weeks in asymptomatic women with a short cervix: Combined effects of cervicovaginal fluid cytokine levels and fetal fibronectin test.

To predict preterm birth (PTB) accurately, we conducted a comprehensive cytokine assay using cervicovaginal fluid (CVF) and evaluated the additive effects of cytokine levels on the fetal fibronectin (fFN) test. A total of 645 CVF samples were collected from 256 asymptomatic pregnant women between 24 and 35 weeks gestation, exhibiting short cervix. After selection based on specific criteria, 17 cytokines in 105 CVF samples were simultaneously measured using multiplex assay. Multivariate logistic regression analysis was performed to evaluate the association between cytokine levels and impending PTB, which is defined as PTB within 2 weeks after CVF collection. Moreover, receiver operating characteristic (ROC) analysis was performed in women with positive fFN results, which was validated using another set of 65 CVF samples. In positive fFN women, the CCL2 level was significantly higher in the impending PTB group than the other group (p < 0.01) and a predictor of impending PTB (adjusted odds ratio 1.020, 95% confidence interval [95% CI] 1.003-1.038, p = 0.020). The cutoff value of CCL2 was 64.8 pg/mL (are under the curve 0.726, p = 0.004, 95% CI 0.593-0.859, sensitivity 45.2%, specificity 91.7%). Additionally, the reliable classification performance of proposed ROC model could be validated. However, measuring cytokine levels could not help in predicting impending PTB in women with negative fFN or normal labor onset in healthy-term women. Comprehensive analysis of CVF cytokines revealed that the CCL2 level significantly improves the prediction of impending PTB in asymptomatic fFN-positive women with a short cervix, which may contribute to better clinical management.

The relationship of preterm birth with fetal fibronectin level in cervicovaginal fluid and cervical lenght in ultrasonography

Objective: In this study, the compatibility between fetal fibronectin determination and the use of cervical length measured by transvaginal ultrasonography of patients who were at risk of preterm birth in the examination performed at 24-34 weeks of gestation, and patients with an increased risk of preterm birth according to the result were defined. &#x0D; &#x0D; Method: 40 patients who applied to Mustafa Kemal University Training and Research Hospital Gynecology and Obstetrics outpatient clinic between May 2021 and May 2022 were included in the study. Fibronectin results were evaluated using the liquid ELISA method taken from the vaginal secretion by a swap. Cervical lengths were evaluated as 25 mm and below, between 25-30 mm and 30 mm and above in statistical data.&#x0D; &#x0D; Results: For fFN-positive patients, the preterm delivery rate of patients with a cervical length of 25 mm and less was determined as 100%, while the rate of preterm birth was determined as 77.8% for patients with a cervical length between 25 mm and 30 mm. In addition, the preterm labor rate of fFN-positive patients with a cervical length of 30 mm and above was determined as 78.57%. &#x0D; &#x0D; Conclusion: All patients with a cervical length of 25 mm or less have a positive fFN test, and a strong correlation can be established between these two values. Accordingly, fFN positivity was found to have a higher sensitivity in determining the probability of preterm delivery compared to the cervical length ratio.

Retraction Note to: Fetal fibronectin (Quick Check fFN test®) for detection of premature rupture of fetal membranes.

Retraction Note to: Fetal fibronectin (Quick Check fFN test®) for detection of premature rupture of fetal membranes.

The Endocannabinoid System - The Prediction of Spontaneous Preterm Birth in High-Risk Women: Protocol of a Study.

Spontaneous preterm birth (sPTB) is a major cause of perinatal morbidity and mortality, even in developed countries. Prediction of sPTB is therefore a valuable tool to reduce the associated risks. The current standard for the prediction of sPTB consists, in addition to anamnestic data, of previous sPTB and previous second trimester miscarriage, measurement of cervical length by transvaginal ultrasound (TVU CL) together with assessment of fetal fibronectin levels in cervicovaginal fluid. Other evaluation parameters, such as the level of endocannabinoids in the pregnant woman's blood, could increase the sensitivity of this management. Endocannabinoids (eCBs) are a part of the endocannabinoid system (ECS); out of them anandamide (arachidonoyl-ethanolamide, AEA), in particular, plays an important role in the regulation of pregnancy and childbirth. We present the protocol for an open, non-randomized study to evaluate concentrations of AEA and other endocannabinoids: 2 linoleoylglycerol (2-AG), 2 linoleoylglycerol (2-LG), 2 oleoylglycerol (2-OG), and 2 arachidonoyldopamine (2-ADOPA or also NADA) in the blood of pregnant women as potential predictors of sPTB. In a total of 230 women with a history of sPTB or miscarriage, eCBs levels between 22 and 28 weeks of gestation will be assessed from maternal blood, in addition to the standard procedure. The aim of the study is to determine the relationship between blood concentrations of the endocannabinoids tested and the risk of sPTB. The results of this study will describe the prognostic significance of maternal blood eCBs levels for sPTB, and could subsequently enable improved screening programs for early identification of sPTB.

Preterm Birth: Screening and Prediction.

Preterm birth (PTB) affects approximately 10% of births globally each year and is the most significant direct cause of neonatal death and of long-term disability worldwide. Early identification of women at high risk of PTB is important, given the availability of evidence-based, effective screening modalities, which facilitate decision-making on preventative strategies, particularly transvaginal sonographic cervical length (CL) measurement. There is growing evidence that combining CL with quantitative fetal fibronectin (qfFN) and maternal risk factors in the extensively peer-reviewed and validated QUanititative Innovation in Predicting Preterm birth (QUiPP) application can aid both the triage of patients who present as emergencies with symptoms of preterm labor and high-risk asymptomatic women attending PTB surveillance clinics. The QUiPP app risk of delivery thus supports shared decision-making with patients on the need for increased outpatient surveillance, in-patient treatment for preterm labor or simply reassurance for those unlikely to deliver preterm. Effective triage of patients at preterm gestations is an obstetric clinical priority as correctly timed administration of antenatal corticosteroids will maximise their neonatal benefits. This review explores the predictive capacity of existing predictive tests for PTB in both singleton and multiple pregnancies, including the QUiPP app v.2. and discusses promising new research areas, which aim to predict PTB through cervical stiffness and elastography measurements, metabolomics, extracellular vesicles and artificial intelligence.

Assessment of cervical softening and the prediction of preterm birth (STIPP): protocol for a prospective cohort study

IntroductionPreterm birth (PTB) is among the leading causes of perinatal and childhood morbidity and mortality. Therefore, accurate identification of pregnant women at high risk of PTB is key to enable...

Role of Uterocervical Angle, Cervical Length, and Cervicovaginal Fetal Fibronectin in the Prediction of Preterm Birth

BACKGROUND:Cervical length measurement and fetal fibronectin (FFN) are widely used to estimate the risk of preterm birth. Another potential predictor of preterm birth is the uterocervical angle, and this additional measurement may improve the risk assessment. This study aimed to predict the onset of labor in women who present with preterm labor through cervical length, uterocervical angle, and FFN.METHODS:A prospective cohort study was carried out on 90 symptomatic women at high risk of preterm labor attending the Gynecology and Obstetrics department at Fayoum University Hospital. FFN in the cervicovaginal fluid was assessed by ELISA technique. The uterocervical angle and cervical length were measured by transvaginal ultrasound. Maternal history and pregnancy data were recorded. Delivery data were subsequently collected.RESULTS:The average age was 21.79 ± 3.3 years, and the average body mass index (BMI) was 24.6 ± 5.8 kg/m2. The mean gestational age (GA) was 32.83 ± 2.3 weeks. Twelve women in our cohort reported previous preterm labor. The cervical length and FFN showed better sensitivity and specificity compared with the uterocervical angle in predicting preterm birth. Logistic regression analysis demonstrated that preterm birth depended only on the cervical length and quantitative FFN.CONCLUSION:The combination of FFN and cervical length could improve preterm birth prediction accuracy.

EP19.14: Fetal fibronectin, cervical length and maternal blood inflammatory markers for predicting impending delivery in twin pregnancies with preterm labour

EP19.14: Fetal fibronectin, cervical length and maternal blood inflammatory markers for predicting impending delivery in twin pregnancies with preterm labour

Role of Uterocervical Angle, Cervical Length and Cervicovaginal Fetal Fibronectin (FFN) for Prediction of Labor Onset in Women Who Present with Preterm Labor

Role of Uterocervical Angle, Cervical Length and Cervicovaginal Fetal Fibronectin (FFN) for Prediction of Labor Onset in Women Who Present with Preterm Labor

EP19.06: Cervix elastography: prediction of preterm delivery in threatened preterm labour and adjunctive role in positive predictive value of fetal fibronectin

EP19.06: Cervix elastography: prediction of preterm delivery in threatened preterm labour and adjunctive role in positive predictive value of fetal fibronectin

Cervicovaginal Fetal Fibronectin Levels in Preterm Labor: Just Association or Reliable Screening Biomarker

Background: Preterm birth (PTB) is a chief reason for neonatal illness and death. Prediction of PTB can prevent complications. The cervico-vaginal fetal fibronectin (fFN) test is a good predictor for preterm labor (PTL) within 7 to 14 days from testing. The levels of fFN are high during the first 16 to 22 weeks of gestation in normal pregnancy before it drops to very low values and rises over again as the gestation reaches term. The current work aimed to assess the association and reliability of cervicovaginal fFN in predicting PTL. Patient and method: The study was cross-sectional that included hundred pregnant (aging from 20–34 years), gestational age ranging (from 24–34 weeks), and presented with abdominal pain. All applicants’ Detailed medical history regarding age, gravidity, and parity were taken from all applicants. Gestational age was calculated through general examination and abdominal and vaginal examination. During speculum vaginal examination, fFN samples were taken from the cervix and were examined for fFN using the quick check for assay. Statistical scrutiny was carried out by SPSS version 17. A p ≤ 0.05 was measured as significant. Result: The mean age was (27.53 ± 4.23), range (of 20–34). Positive fFN results were detected in only (22%) of patients. Around two-thirds of the women end their pregnancy by normal vaginal delivery. Less than half (45.5%) of the included women delivered within one week after presentation, around 1/3rd (31.8%) delivered after the second week, and only 22.2% delivered during the first day of presentation. There was a significant association between pregnancy outcome and fFN results. A majority (90.9%) of patients end with preterm labor during 2 weeks of follow-up were presented with positive fetal fibronectin. The majority (90.9%) of patients end with preterm labor during 2 weeks of follow-up were presented with positive fFN results. There were non-significant variations between means of gestational ages, parity, and gestational age/weeks between those with positive and negative fFN results. Conclusion: Among pregnant women with uterine contraction before advanced cervical dilatation, the presence of cervicovaginal fFN is an associated and reliable screening test in predicting the risk of PTL.