The Preterm Prediction Study: Sequential cervical length and fetal fibronectin testing for the prediction of spontaneous preterm birth - 05/09/11
for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Abstract |
Objectives: This study was undertaken to further elucidate the pathogenesis of preterm birth by means of traditional risk factors and new markers for preterm birth derived from the Preterm Prediction Study. Study Design: A total of 3076 women (2929 with singleton gestations and 147 with twin pregnancies) were categorized according to the presence of risk factors including black race, low body mass index, the presence of bacterial vaginosis, and previous preterm birth. At 24 and 28 weeks’ gestation cervical length was measured and categorized as short (≤25 mm) or normal (>25 mm). Vaginal and cervical fetal fibronectin concentrations were measured at 24, 26, 28, and 30 weeks’ gestation and results were categorized as positive (≥50 ng/mL) or negative (<50 ng/mL). Results: At 24 to 26 weeks’ gestation women with each of the risk factors were more likely to have positive fibronectin test results or to have a short cervix. Among women with negative fetal fibronectin results at 24 to 26 weeks’ gestation those with a short cervix were more likely to have positive fetal fibronectin results at 28 to 30 weeks’ gestation, and among those with normal cervical length those women who had positive fetal fibronectin results were more likely to have a short cervix at later evaluation. Most women who had positive fetal fibronectin results at 24 to 26 weeks’ gestation had negative results at 28 to 30 weeks’ gestation, whereas most but not all women who had a short cervix at 24 to 26 weeks’ gestation still had a short cervix at 28 to 30 weeks’ gestation. In each period women with both a positive fetal fibronectin result and a short cervix were at substantially increased risk of spontaneous preterm birth; women with either marker alone had intermediate and approximately equal risks of spontaneous preterm birth, and women without either marker had a low risk of spontaneous preterm birth. Conclusion: Regardless of other risk factors, a short cervix predicts a subsequent positive fetal fibronectin result, and a positive fetal fibronectin result predicts subsequent cervical shortening. These data do not support a single sequence of events leading to spontaneous preterm birth. (Am J Obstet Gynecol 2000;182:636-43.)
Le texte complet de cet article est disponible en PDF.Keywords : Cervical ultrasonography, fetal fibronectin, preterm birth
Plan
| * | Supported by National Institute of Child Health and Human Development grants HD21410, HD21414, HD21434, HD27860, HD27861, HD27869, HD27883, HD27889, HD27905, HD27915, HD27917, and HD19897. |
| ** | Reprints not available from the authors. |
Vol 182 - N° 3
P. 636-643 - mars 2000 Retour au numéro
Article précédent
- The Preterm Prediction Study: Cervical lactoferrin concentration, other markers of lower genital tract infection, and preterm birth
- Robert L. Goldenberg, W.W. Andrews, R.L. Guerrant, Mercy Newman, Brian Mercer, Jay Iams, Paul Meis, Atef Moawad, Anita Das, J.Peter VanDorsten, Steve N. Caritis, Gary Thurnau, Sidney Bottoms, Menachem Miodovnik, Donald McNellis, James M. Roberts, for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
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- Mikiya Nakatsuka, Toshihiro Habara, Yasuhiko Kamada, Katsuhiko Tada, Takafumi Kudo
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