Fetal fibronectin detection for preterm birth prediction

Abstract

ABSTRACT. To study preterm birth prediction based on fetal fibronectin (fFN) in pregnant women, we randomly selected 124 patients. Vaginal posterior fornix secretions were analyzed using fFN quick test strips. Leucorrhea routine samples were collected to detect bacterial vaginosis, mycoplasma, and chlamydia. Delivery data at 7 days, 14 days, 34 weeks, and 37 weeks were documented and the sensitivity, specificity, positive predictive value, and negative predictive value were analyzed. Of the 124 cases, we found 2, 4, 10, and 18 cases of maternity within 7 days, 14 days, 34 weeks, and 37 weeks, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were as follows: 100, 77.8, 6.9, and 100% for 7 days; 75, 78.3, 10.3, and 98.9% for 14 days; 50.0, 78.9, 17.2, and 94.7% for 34 weeks; 33.3, 78.3, 20.7, and 87.4% for 37 weeks, respectively. Except for 18 preterm births, 23 cases were fFN-positive, 17 cases had lower genital tract infection. Eighty- three cases were fFN-negative, of which 18 cases had the lower genital tract infections. This difference was statistically significant (P < 0.05). Eighteen cases (14.5% of the pregnant women) had preterm birth. Ten cases delivered within 34 weeks. The negative predictive value and recent predictive value of fFN testing were higher; the positive predictive value was limited due to the impact of lower genital tract infection. The fFNpositive patients need timely clinical processing. During the pregnancy, monitoring of fFN changes and early detection of abnormalities help to reduce perinatal morbidity and mortality.

Prediction of preterm delivery in symptomatic women using PAMG‐1, fetal fibronectin and phIGFBP‐1 tests: systematic review and meta‐analysis

“…Overall, 14 studies (n = 2278 women) 15,17,20,21,30,40-48 reporting on PAMG-1, 40 (n = 7431 women) 14,15,18,20,22,28,29,[40][41][42] on fFN and 22 (n = 3192 women) 16,18,19,28,30,48,54,73,[79][80][81][82][83][84][85][86][87][88][89][90][91][92] on phIGFBP-1 were included in the final analysis. Of these, 11 studies included performance metrics for more than one biomarker.…”

“…The sample size of the included studies ranged from 22 77 to 725 52 (mean, 158) subjects. 20 Fatkullin (2016) 45 Hadzi-Lega (2017) 48 Heverhagen (2015) 17 Konoplyannikov (2016) 47 Lotfi (2015) 44 Lou (2016) 46 Melchor (2018) 40 Nikolova (2015) 42 Nikolova (2017) 30 Ravi (2017) 43 Van Holsbeke (2016) 41 Wing (2017) Bartnicki (1996) 49 Benattar (1997) 62 Bruijn (2016) 28 Çekmez (2017) 20 Cheung (2013) 77 Closset (2001) 68 Desjardins (2008) 53 Diaz (2009) 75 Eroglu (2007) 73 Foxman (2004) 56 Gao (2014) 22 Giles (2000) 71 Gomez (2005) 74 Groom (2006) 59 Henrich (2010) 60 Iams (1995) 14 LaShay (2000) 55 Liong (2015) 66 Lopez (2000) 70 Lowe (2004) 63 Luzzi (2003) 58 MacDonald (2007) 50 Magro-Malosso (2017) 78 Malak (1996) 65 McKenna (1999) 72 Melchor (2018) 40 Nikolova (2015) 42 Peaceman (1997) 52 Riboni (2011) 54 Sakai (2003) 51 Senden (1996) 76 Skoll (2006) …”

“…Concomitantly, the predictive values associated with each biomarker also vary. Positive predictive values (PPV) for PAMG‐1, fFN and phIGFBP‐1 range from 23.1% to 100%, 4.3% to 92.3% and 2.2% to 81.3%, respectively, and negative predictive values (NPV) range from 93.0% to 100%, 73.2% to 100% and 61.8% to 98.4%, respectively. The range of predictive values presents a challenge to clinicians evaluating biomarker tests of their population, which may have a different pretest probability of sPTB ≤ 7 days from that reported by any one study.…”

Evaluation of quantitative fFn test in predicting the risk of preterm birth

“…The most used fFN bedside test (Rapid fFN TLI IQ ; Hologic, Marlborough, MA, USA) is a qualitative test that provides a positive or negative result based on a single fFN threshold of 50 ng/mL, although limited data regarding the selection and the accuracy of this cut-off point are available. It follows that the test in symptomatic women has a good negative predictive value (NPV) > 90% [7][8][9][10][11][12], but has a low positive predictive value (PPV) from < 20% to 40% [7,13,8,11] for predicting delivery before 34 weeks' gestation or within 14 days from testing with the consequence that a high number of pregnant women with a positive qualitative fFN test will not deliver preterm.…”

Risk Assessment for Preterm Delivery using the Fetal Fibronectin Test Associated with the Measurement of Uterine Cervix Length in Symptomatic Pregnant Women

“…Nevertheless, these risk factors occur in only 50% of all PTD cases, and they eventually contribute to the identification of risk pregnancies. [4][5][6][7] The most important risk factor is a history of prior PTD. 8,9 Recent studies demonstrate that the incidence of prematurity can be attenuated through the use of the MUCL, evaluated at the end of the second trimester by transvaginal ultrasonography (TVUS), to predict the probability of spontaneous PTD.…”