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The diagnosis and management of preterm labor with intact membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Tinnakorn Chaiworapongsa, Francesca Gotsch, Lami Yeo, Ichchha Madan, Sonia S. Hassan
The clinical assessment of patients presenting with symptoms of preterm labor should include (i) a history of previous pregnancies and risk factors (e.g., prior preterm delivery, prior second-trimester abortion); (ii) current pregnancy status; (iii) presenting complaint(s); (iv) physical examination; (v) monitoring of fetal heart rate and uterine contractions; (vi) vaginal examination (speculum and/or digital); (vii) collection of cervicovaginal samples for microbiology (streptococcus group B (GBS), chlamydia, gonorrhea, Gram stain for bacterial vaginosis (BV)); (viii) urinalysis, culture, and sensitivity; (ix) amniocentesis; (x) fetal fibronectin; and (xi) ultrasound (estimated fetal weight, number of fetuses, placental location, fetal presentation and lie, amniotic fluid volume, and transvaginal cervical length).
Management of pregnancy with recurrent preterm deliveries
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Fetal fibronectin test: Fibronectin is a glycoprotein present in maternal blood as well as amniotic fluid. Although the ACOG (2012) does not recommend routine use of the fetal fibronectin test, fibronectin can be detected in cervicovaginal secretions normally before 20 weeks, and if present thereafter, it acts as a marker of possible preterm labor. Women with positive fibronectin test have more risk of spontaneous preterm delivery (28%) compared with those with negative test results (7%). Short cervical length (less than 25 mm) poses a threat of spontaneous delivery before term and when combined with a positive fetal fibronectin test, the risk increases to 64% [11].
Pre-labour rupture of the membranes
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Fetal fibronectin is a protein found at the chorio-decidual junction rather than being found in high concentration in amniotic fluid. Testing for presence of fFN is commonly used to determine the risk of preterm labour in women with intact membranes and has been postulated for use in the diagnosis of PROM. fFN testing has been shown to become negative in some women after membranes have been ruptured for more than 12 hours if liquor is not seen on speculum examination. It should be noted that none of these technologically advanced tests for the detection of PROM have been evaluated against the true gold standard for the detection of PROM: the amnio-dye test.
A diagnostic profile on the PartoSure test
Published in Expert Review of Molecular Diagnostics, 2020
Safoura Rouholamin, Maryam Razavi, Mahroo Rezaeinejad, Mahdi Sepidarkish
Fetal fibronectin is a glycoprotein protein produced by fetal cells. It is found in placental tissue, amniotic fluid, and at the interface of the chorion and the decidua (between the fetal sac and the uterine lining). This fibronectin protein acts as an adhesive or ‘biological glue’ and binds the fetal sac to the uterine lining. Fetal fibronectin released into cervicovaginal fluid if the connection is disrupted. So the positive test for fFN (>50 ng/ml) between week 22 and week 34 of pregnancy can be a sign that the PTB is imminent [24]. Vaginal bleeding interferes with test results and bloody samples may lead to false-positive results. It is recommended that the sample be collected following the cessation of active vaginal bleeding [25]. A comprehensive systematic review by Faron et al. in 2018 reported that none of the summary estimates was over 10 for LR+ and lower than 0.1 for LR-. The authors conclude that the fFN test should not be used as a screening test for asymptomatic women. Also, the test application is not valid for asymptomatic women at high risk and could not be used in practice especially for women with multiple pregnancies [26].
Clinical factors and ultrasound parameters to predict successful vaginal delivery following labour induction
Published in Journal of Obstetrics and Gynaecology, 2020
Young Bin Won, Sang Won Han, Eui Hyeok Kim
The limitations of this study were its small population size, the heterogeneous nature of the indications for labour induction, and differences in the methods used to induce labour. Since this study was based on data collected from a single institution and examinations were performed by a single obstetrician, the results may not be generalisable. Further studies involving a larger population are needed to fully corroborate this study’s results. According to Uygur et al. (2016), foetal fibronectin levels may become a more valuable predictive indicator of the successful induction of labour compared to ultrasound parameters and Bishop scores, although higher costs are a likely a drawback. Further analysis utilising this indicator could be applied to a future study in order to provide a more inclusive database.
Identification of preterm birth in women with threatened preterm labour between 34 and 37 weeks of gestation
Published in Journal of Obstetrics and Gynaecology, 2018
Cenk Gezer, Atalay Ekin, Ulas Solmaz, Alkim Gulsah Sahingoz Yildirim, Askin Dogan, Mehmet Ozeren
The design of the present study did not enable correlation between foetal fibronectin and biochemical markers. However, some authors have compared the ability of foetal fibronectin testing with other markers to predict preterm birth in patients with varying degrees of success. Various markers that are associated with preterm birth have been assessed, but very few have shown clinical usefulness compared to fibronectin (Chan 2014). Recent research suggests insulin-like growth factor-binding protein-1 (IGFBP-1) as a potentially promising biomarker. Riboni et al. (2011) and Ting et al. (2007) found that IGFBP-1 was a better marker than foetal fibronectin for predicting preterm delivery. However, little information on the sensitivity, specificity and positive predictive value is known at this time to determine the clinical usefulness of IGFBP-1.