Significance of fetal fibronectin and cytokine measurement in the cervicovaginal secretions of women at term in predicting term labor and post-term pregnancy

Imai, Manami; Tani, Akihiro; Saito, Maki; Saito, Kazuru; Amano, Kazutaka; Nisijima, Masahiro

doi:10.1016/s0301-2115(00)00483-8

Cited by 17 publications

(10 citation statements)

References 33 publications

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“…17 Although the predictive properties of IL-1 and IL-1ra in this current study (either individually or in combination) cannot be directly compared with these previous fFN and IL-1b studies due to different sample-to-delivery time frames and study populations, we believe the combination of the 3 biomarkers (Il-1a, IL-1b, and IL-1ra) to predict spontaneous labor compares favorably to fFN with improved PPV.…”

Section: Discussionmentioning

confidence: 67%

The Interplay of the Interleukin 1 System in Pregnancy and Labor

et al. 2013

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This work assessed the temporal coexpression of interleukin 1 (IL-1) and its inhibitor, IL-1 receptor antagonist (IL-1ra), in the cervicovaginal fluid (CVF) beyond 24 weeks gestation including women in spontaneous term labor. Two cohorts of women were recruited at 24 to 35 weeks' gestation (n ¼ 65) and in late pregnancy (>36 weeks' gestation; n ¼ 88). The CVF was serially collected either every 4 weeks between 24 and 35 weeks' gestation (n ¼ 123 samples) or weekly during late pregnancy (n ¼ 240 samples). The IL-1 and IL-1ra were quantitated by enzyme-linked immunosorbent assay, and the effect of vaginal microflora and unprotected sexual intercourse were also investigated. The IL-1b and IL-1ra remain unaltered between 24 and 35 weeks' gestation. At late pregnancy, IL-1a and b concentrations peak at 4 to 14 days prior to labor onset, while IL-1ra decreases with approaching spontaneous term labor (P < .05, 2-way analysis of variance). The IL-1 and IL-1ra were significantly correlated (P < .001, Pearson r). A combined biomarker model of IL-1a, IL-1b, and IL-1ra can predict term labor with 86% sensitivity and 92% specificity. This study indicates a shifting inflammatory balance in the gestational tissues prior to labor onset.

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Section: Discussionmentioning

confidence: 67%

The Interplay of the Interleukin 1 System in Pregnancy and Labor

et al. 2013

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“…With the development of genomic and proteomic technologies over the past two decades the simultaneous screening of thousands of genes and gene products from small samples of tissue or body fluid has become possible [ 26 – 29 ]. However, it is becoming evident that single biomarker approaches for the early detection of preterm birth (in the absence of infection) may never achieve the desired diagnostic efficiency [ 23 , 24 , 30 , 31 ].…”

Section: Current Approaches To the Prediction Of Preterm Labourmentioning

confidence: 99%

Predicting Preterm Labour: Current Status and Future Prospects

et al. 2015

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Preterm labour and birth are a major cause of perinatal morbidity and mortality. Despite modern advances in obstetric and neonatal management, the rate of preterm birth in the developed world is increasing. Yet even though numerous risk factors associated with preterm birth have been identified, the ability to accurately predict when labour will occur remains elusive, whether it is at a term or preterm gestation. In the latter case, this is likely due to the multifactorial aetiology of preterm labour wherein women may display different clinical presentations that lead to preterm birth. The discovery of novel biomarkers that could reliably identify women who will subsequently deliver preterm may allow for timely medical intervention and targeted therapeutic treatments aimed at improving maternal and fetal outcomes. Various body fluids including amniotic fluid, urine, saliva, blood (serum/plasma), and cervicovaginal fluid all provide a rich protein source of putative biochemical markers that may be causative or reflective of the various pathophysiological disorders of pregnancy, including preterm labour. This short review will highlight recent advances in the field of biomarker discovery and the utility of single and multiple biomarkers for the prediction of preterm birth in the absence of intra-amniotic infection.

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“…The presence of biochemical markers, such as fetal fibronectin (fFN) -a glycoprotein produced at the choriodecidual interface -in cervicovaginal fluid is associated with significantly shorter delivery intervals. Analysis of fFN in 122 pregnant women shows that levels begin to increase around 3 weeks before parturition and a positive correlation exists between fFN concentration and time to delivery [19]. Furthermore, a meta-analysis has confirmed that fFN levels are predictive of successful induction (likelihood ratio ¼ 1.49, 95% CI: 1.20-1.85) [15] whereas a low Bishop score combined with a negative fFN test is likely to result in failure of induction.…”

Section: Timing Of Induction: the Predictive Toolsmentioning

confidence: 98%

Induction of labour

Blickstein

2009

The Journal of Maternal-Fetal & Neonatal Medicine

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Indications and ratesLabour induction is a routine procedure in obstetrical care and performed for various maternal, fetal and non-medical reasons. Widely accepted indications for labour induction include post-term pregnancy, maternal hypertension, premature rupture of membranes, fetal growth restriction, non-reassuring fetal status, polyhydramnios, intrauterine/fetal infection and previous obstetric history [1].It is difficult to compare induction rates from various locations due to differences in the classification of induced and augmented labour. Data from the USA showed a two-fold increased induction rate between 1990 and 2005 ( Figure 1) [2]. This increase in induction was mirrored by an increase in the caesarean section rate from 23% in 1990 to 30% in 2005 [2]. However, induction rates in England appear to have remained relatively constant between 1995 and 2005 at around 20% with an increase in planned caesarean sections from 7% to 11% during the same period [3]. An unpublished study from Utah in the USA suggests inappropriate induction of labour is common; a large decrease in elective labour inductions at 539 weeks was observed when physicians were required to obtain permission for induction from an expert in maternal-fetal medicine. The physiological process of cervical ripeningInduction of labour occurs in two stages: a preinduction phase involving cervical ripening followed by induction of uterine contractions. The cervix is composed of collagen, elastic tissue and muscle fibres together with a proteoglycan stroma. As pregnancy advances, vascularity increases and neutrophils and macrophages infiltrate the tissue. Infiltrating cells and resident fibroblasts subsequently secrete collagenase and elastase to remodel the cervix and allow softening, ripening and eventual dilation.

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Significance of fetal fibronectin and cytokine measurement in the cervicovaginal secretions of women at term in predicting term labor and post-term pregnancy

Cited by 17 publications

References 33 publications

The Interplay of the Interleukin 1 System in Pregnancy and Labor

The Interplay of the Interleukin 1 System in Pregnancy and Labor

Predicting Preterm Labour: Current Status and Future Prospects

Induction of labour

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