Quantitative fetal fibronectin testing in combination with cervical length measurement in the prediction of spontaneous preterm delivery in symptomatic women

M. M.C. Bruijn, J. Y. Vis, F. F. Wilms, M. A. Oudijk, A. Kwee, M. M. Porath, G. Oei, H. C.J. Scheepers, M. E.A. Spaanderman, K. W.M. Bloemenkamp, M. C. Haak, A. C. Bolte, F. P.H.A. Vandenbussche, M. D. Woiski, C. J. Bax, J. M.J. Cornette, J. J. Duvekot, B. W.A. Nij Bijvanck, J. van Eyck, M. T.M. FranssenK. M. Sollie, J. A.M. van der Post, P. M.M. Bossuyt, B. C. Opmeer, M. Kok, B. W.J. Mol, G. J. van Baaren

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Abstract

Objective: To evaluate whether in symptomatic women, the combination of quantitative fetal fibronectin (fFN) testing and cervical length (CL) improves the prediction of preterm delivery (PTD) within 7 days compared with qualitative fFN and CL. Design: Post hoc analysis of frozen fFN samples of a nationwide cohort study. Setting: Ten perinatal centres in the Netherlands. Population: Symptomatic women between 24 and 34 weeks of gestation. Methods: The risk of PTD <7 days was estimated in predefined CL and fFN strata. We used logistic regression to develop a model including quantitative fFN and CL, and one including qualitative fFN (threshold 50 ng/ml) and CL. We compared the models’ capacity to identify women at low risk (<5%) for delivery within 7 days using a reclassification table. Main outcome measures: Spontaneous delivery within 7 days after study entry. Results: We studied 350 women, of whom 69 (20%) delivered within 7 days. The risk of PTD in <7 days ranged from 2% in the lowest fFN group (<10 ng/ml) to 71% in the highest group (>500 ng/ml). Multivariable logistic regression showed an increasing risk of PTD in <7 days with rising fFN concentration [10–49 ng/ml: odds ratio (OR) 1.3, 95% confidence interval (95% CI) 0.23–7.0; 50–199 ng/ml: OR 3.2, 95% CI 0.79–13; 200–499 ng/ml: OR 9.0, 95% CI 2.3–35; >500 ng/ml: OR 39, 95% CI 9.4–164] and shortening of the CL (OR 0.86 per mm, 95% CI 0.82–0.90). Use of quantitative fFN instead of qualitative fFN resulted in reclassification of 18 (5%) women from high to low risk, of whom one (6%) woman delivered within 7 days. Conclusion: In symptomatic women, quantitative fFN testing does not improve the prediction of PTD within 7 days compared with qualitative fFN testing in combination with CL measurement in terms of reclassification from high to low (<5%) risk, but it adds value across the risk range. Tweetable abstract: Quantitative fFN testing adds value to qualitative fFN testing with CL measurement in the prediction of PTD.

Original languageEnglish
Pages (from-to)1965-1971
Number of pages7
JournalBJOG : An International Journal of Obstetrics and Gynaecology
Volume123
Issue number12
DOIs
Publication statusPublished - 1 Nov 2016

Keywords

  • Cervical length
  • prediction
  • pregnancy
  • preterm labour
  • quantitative fetal fibronectin

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