Article

Predictive Value of Cervical Length Measurement and Fibronectin Testing in Threatened Preterm Labor

Obstetrics and Gynecology (Impact Factor: 5.18). 05/2014; 123(6). DOI: 10.1097/AOG.0000000000000229
Source: PubMed

ABSTRACT

To estimate the performance of combining cervical length measurement with fetal fibronectin testing in predicting delivery in women with symptoms of preterm labor.
We conducted a prospective nationwide cohort study in all 10 perinatal centers in The Netherlands. Women with symptoms of preterm labor between 24 and 34 weeks of gestation with intact membranes were included. In all women, qualitative fibronectin testing (0.050-microgram/mL cutoff) and cervical length measurement were performed. Logistic regression was used to predict spontaneous preterm delivery within 7 days after testing. A risk less than 5%, corresponding to the risk for women with a cervical length of at least 25 mm, was considered as low risk.
Between December 2009 and August 2012, 714 women were enrolled. Fibronectin results and cervical length were available for 665 women, of whom 80 (12%) delivered within 7 days. Women with a cervical length of at least 30 mm or with a cervical length between 15 and 30 mm with a negative fibronectin result were at low risk (less than 5%) of spontaneous delivery within 7 days. Fibronectin testing in case of a cervical length between 15 and 30 mm additionally classified 103 women (15% of the cohort) as low risk and 36 women (5% of the cohort) as high risk.
Cervical length measurement, combined with fetal fibronectin testing in case of a cervical length between 15 and 30 mm, improves identification of women with a low risk to deliver spontaneously within 7 days. LEVEL OF EVIDENCE:: II.

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Available from: Gert-Jan Van Baaren, May 29, 2014
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    • "For our study we used data from one prospective cohort study and three multicentre randomised controlled trials (RCTs) on preterm birth performed in the Dutch consortium for women's health research between 2006 and 2012. The prospective cohort study was the APOSTEL I (NTR 1857), which evaluated the use of fetal fibronectin testing and cervical length in 714 women with threatened preterm labour [12]. The APOSTEL II-trial (NTR 1336) compared maintenance tocolysis with nifedipine to placebo in 406 women with threatened preterm labour [13]. "
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