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Fetal fibronectin does not affect outcomes of preterm labour

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7455.0-f (Published 24 June 2004) Cite this as: BMJ 2004;328:0-f

Question Does use of fetal fibronectin in management of preterm labour affect age at delivery or rates of interventions?

Synopsis Fetal fibronectin evaluation has been introduced to try to discriminate between women who are more or less likely to deliver preterm on presentation to labour and delivery for symptoms of preterm labour. It has not been shown to influence outcomes. Women at 23 to 34 weeks' gestation were randomised (allocation concealed) to testing of fetal fibronectin (n = 46) or not (n = 51). Fetal fibronectin results were available within approximately one hour to the physicians of the women in the tested group. There were no differences between groups for median gestational age at delivery, hours spent in labour and delivery, rate of inpatient admissions, or use of corticosteroids, antibiotics, or magnesium sulphate. Within the group tested with fetal fibronectin there were significant differences between those with positive and negative test results for more hours spent in labour and delivery and higher rate of inpatient admission among those who tested positive. The observed sensitivity and specificity of fetal fibronectin for birth within seven days was 67% and 79%, respectively. The positive predictive value for delivery within seven days was 18% and negative predictive value was 97%.

Bottom line Use of fetal fibronectin in the assessment of women presenting to labour and delivery units with symptoms of preterm labour does not affect the gestational age at delivery, frequency of use of medical interventions, length of stay in labour and delivery, or rate of inpatient admissions.

Level of evidence 1b (see www.infopoems.com/levels.html).Independent blind comparison of an appropriate spectrum of consecutive patients, all of whom have undergone both the diagnostic test and the reference standard; or a clinical decision rule not validated on a second set of patients.

Lowe MP, Zimmerman B, Hansen W. Prospective randomized controlled trial of fetal fibronectin on preterm labor management in a tertiary care center.Am J Obstet Gynecol 2004;190: 358-62.

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Footnotes

  • Patient-Oriented Evidence that Matters. See editorial (BMJ 2002;325: 983)

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