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Quantitative fetal fibronectin testing in combination with cervical length measurement in the prediction of spontaneous preterm delivery in symptomatic women
Author(s) -
Bruijn MMC,
Vis JY,
Wilms FF,
Oudijk MA,
Kwee A,
Porath MM,
Oei G,
Scheepers HCJ,
Spaanderman MEA,
Bloemenkamp KWM,
Haak MC,
Bolte AC,
Vandenbussche FPHA,
Woiski MD,
Bax CJ,
Cornette JMJ,
Duvekot JJ,
Nij Bijvanck BWA,
Eyck J,
Franssen MTM,
Sollie KM,
Post JAM,
Bossuyt PMM,
Opmeer BC,
Kok M,
Mol BWJ,
Baaren GJ
Publication year - 2016
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13752
Subject(s) - fetal fibronectin , medicine , confidence interval , logistic regression , odds ratio , preterm delivery , obstetrics , gestation , gynecology , pregnancy , biology , genetics
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.