Fetal fibronectin as a predictor of preterm birth in patients with symptoms: A multicenter trial

Peaceman, Alan M.; Andrews, William; Thorp, John M.; Cliver, Suzanne P.; Lukes, Andrea S.; Iams, Jay D.; Coultrip, Laura; Eriksen, Nancy L.; Holbrook, R. Harold; Elliott, John P.; Ingardia, Charles J.; Pietrantoni, Marcello

doi:10.1016/s0002-9378(97)70431-9

Cited by 361 publications

(166 citation statements)

References 13 publications

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“…In parallel, the low umbilical blood PAPP-A values make a possible fetal signal less likely. The high positive predictive value of 81% in conjunction with a negative predictive value of 62% for delivery within 7 days is comparable and perhaps superior to that reported 28 for fetal fibronectin in patients with symptoms of preterm birth (23 and 93% respectively). Thus, we will withhold intervention in patients with a negative result while supporting intervention for those in the risk group.…”

Section: Discussionsupporting

confidence: 59%

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PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study

et al. 2007

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Objective: To evaluate late PAPP-A levels as predictive of preterm birth in symptomatic women.Study Design: Prospective cohort study of singleton gestations, 23 to 34 weeks, and symptoms of preterm labor. PAPP-A, IGF-I and IGF-III analysis were performed. Primary end point was delivery p7 days. Accuracy and optimally predictive PAPP-A values were based on receiver operator characteristic (ROC) curves.Result: In all, 26 women (51%) delivered p7 days post-admission (Group 1); 25 women (49%) >7 days (Group 2). Group 1 mean PAPP-A ¼ 38 000 vs 55 333 for Group 2 (P<0.04). Group 1 mean gestational age at delivery ¼ 29 weeks vs 37 weeks for Group 2 (P<0.00014). PAPP-A level p30 000 mU l À1 had highest specificity (88%), sensitivity (50%), and positive predictive (81%) and negative predictive (62%) values for delivery p7 days. ROC area under curve ¼ 0.703.Conclusion: PAPP-A levels p30 000 mU l À1 at admission was associated with increased risk for preterm birth p7 days, supporting active management and therapeutic approach in these women.

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Section: Discussionsupporting

confidence: 59%

“…28 This cohort, while relatively small, has a minimal number of maternal confounding variables because socio-economic factors were rather uniform and an unbiased standard protocol was used. However, there may be other potential confounders that we did not consider or that were not available for analysis.…”

Section: Discussionmentioning

confidence: 99%

PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study

et al. 2007

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“…If we treated only those women with a positive test result we would need to treat 17, a figure considerably lower than that without testing This approach will allow clinicians to make explicit decisions on the basis of more realistic probabilities generated by fibronectin testing and provides a framework for the use of diagnostic evidence in therapeutic decision making. Specifically, our results enable clinicians to make a more rational approach to Peaceman (1997) 65 Lukes (1997) 62 Peaceman (1996) 65 Iams (1995) 60 Giles (2000) 58 Benattar (1997) 22 Lopez (2000) 59 Malak (1996) 63 Coleman (2001) 47 McKenna (1999) 64 McKenna (1999) 64 Senden (1996) 50 LaShay (2000) 51 Bartnicki (1996) 21 Leeson (1996) 61 Peaceman (1997) 65 Coleman (1998) 46 Overall (95% CI) Likelihood ratios for positive test result…”

Section: Clinical Applicationmentioning

confidence: 85%

“…Future research should focus on undertaking high quality primary studies of test accuracy to improve our ability to predict spontaneous preterm birth. Peaceman (1997) 65 Peaceman (1997) 65 Lockwood (1991) 8 Rizzo (1997) 92 Rizzo (1996) 91 Rizzo (1996) 91 Bartnicki (1996) 21 Iams (1995) 60 Malagrida (1995) 82 Calda (1995) 85 Lopez (2000) 59 Malak (1996) 63 Irion (1995) 88 Rozenberg (1997) 93 Hampl (1994) 54 Mansouri (1997) 98 Chuileannain (1998) 95 Giles (2000) 58 Malagrida (1995) 82 Langer (1997) 89 Goffeng (1997) LaShay (2000) 31 Benattar (1997) Inglis (1994) 79 Peaceman (1997) 65 Vetr (1996) 96 Grandi (1996) 48 Surbek (1997) 83 Roubille (1999) 84 Vercoustre (1996) 81 Vercoustre (1996) 81 Nageotte (1992) 70 Morrison (1993) 49 Overall (95% CI) …”

Section: Fig 13mentioning

confidence: 99%

Accuracy of cervico-vaginal fetal fibronectin test in predicting the risk of spontaneous preterm birth—a systematic review

Honest

Bachmann²,

Kleijnen³

et al. 2003

Journal of Obstetrics and Gynaecology

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Objective To determine the accuracy with which a cervicovaginal fetal fibronectin test predicts spontaneous preterm birth in women with or without symptoms of preterm labour. Design Systematic quantitative review of studies of test accuracy. Data sources Medline, Embase, PASCAL, Biosis, Cochrane Library, Medion, National Research Register, SCISEARCH, conference papers, manual searching of bibliographies of known primary and review articles, and contact with experts and manufacturer. Study selection Two reviewers independently selected and extracted data on study characteristics, quality, and accuracy. Data extraction Accuracy data were used to form 2×2 contingency tables with spontaneous preterm birth before 34 and 37 weeks' gestation and birth within 7-10 days of testing (for symptomatic pregnant women) as reference standards. Data were pooled to produce summary receiver operating characteristic curves and summary likelihood ratios for positive and negative test results. Data synthesis 64 primary articles were identified, consisting of 28 studies in asymptomatic women and 40 in symptomatic women, with a total of 26 876 women. Among asymptomatic women the best summary likelihood ratio for positive results was 4.01 (95% confidence interval 2.93 to 5.49) for predicting birth before 34 weeks' gestation, with corresponding summary likelihood ratio for negative results of 0.78 (0.72 to 0.84). Among symptomatic women the best summary likelihood ratio for positive results was 5.42 (4.36 to 6.74) for predicting birth within 7-10 days of testing, with corresponding ratio for negative results of 0.25 (0.20 to 0.31). Conclusion Cervicovaginal fetal fibronectin test is most accurate in predicting spontaneous preterm birth within 7-10 days of testing among women with symptoms of threatened preterm birth before advanced cervical dilatation.

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“…3,4 To prevent prematurity, the ideal course of action would be to predict which patients are at risk of premature delivery and then implement effective intervention. [5][6][7] In several studies, bacterial vaginosis has been associated with prematurity and other adverse outcomes, independent of other known risk factors. [8][9][10][11][12] While bacterial vaginosis has been associated with preterm delivery and low birth weight, randomized trials for the treatment of bacterial vaginosis during pregnancy have not always demonstrated a reduction in such outcomes.…”

Section: Introductionmentioning

confidence: 99%

Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: a retrospective cohort study

et al. 2005

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CONTEXT AND OBJECTIVE: Bacterial vaginosis has been associated with prematurity and other perinatal complications. However, the efficacy of the treatment for preventing such complications has not yet been well established. The objective of this study was to evaluate the impact of treatment for bacterial vaginosis on a low-risk population of Brazilian pregnant women, in order to prevent prematurity and other perinatal complications. DESIGN AND SETTING: Observational retrospective cohort study, at the Obstetric and Gynecology Department, Universidade Estadual de Campinas (Unicamp). METHODS: Vaginal bacterioscopy results from 785 low-risk pregnant women were studied. Three different groups of women were identified: 580 without bacterial vaginosis during pregnancy, 134 with bacterial vaginosis treated using imidazoles (metronidazole, tinidazole, or secnidazole) during pregnancy, and 71 with bacterial vaginosis not treated during pregnancy. The diagnosis of bacterial vaginosis was based on Nugent's criteria, from the vaginal bacterioscopy performed during the first prenatal care visit. RESULTS: The frequency of prematurity was 5.5% among the women without bacterial vaginosis, 22.5% among those with untreated bacterial vaginosis and 3.7% among those with treated bacterial vaginosis. The risk ratios for perinatal complications were significantly higher in the group with untreated bacterial vaginosis: premature rupture of membranes, 7.5 (95% CI: 1.9-34.9); preterm labor, 3.4 (95% CI: 1.4-8.1); preterm birth, 6.0 (95% CI: 1.9-19.7); and low birth weight, 4.2 (95% CI: 1.2-14.3). CONCLUSION: The treatment of bacterial vaginosis significantly reduced the rates of prematurity and other perinatal complications among these low-risk Brazilian pregnant women, regardless of the history of previous preterm delivery.

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Fetal fibronectin as a predictor of preterm birth in patients with symptoms: A multicenter trial

Cited by 361 publications

References 13 publications

PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study

PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study

Accuracy of cervico-vaginal fetal fibronectin test in predicting the risk of spontaneous preterm birth—a systematic review

Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: a retrospective cohort study

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