SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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U. Lüthi1 , Ch. Meier2 , G. Schär2 , A.R. Huber1

1Department of Laboratory Medicine, Kantonsspital Aarau, 2Department of Obstetrics and Gynecology, Kantonsspital Aarau

Introduction: After testing the fetal fibronectin about its validity for preterm births < 36+0 week of gestation in an earlier study (Sensitivity 83%, Specificity 61%, PPV 61%, NPV 94%) we have incorporated the results of fetal fibronectin in the management of pregnant women with clinical warn signs for preterm delivery.
Patients and methods: Between march 2003 and january 2004 we have tested the fetal fibronectin of 58 patients at risk of preterm delivery. If the result of fetal fibronectin was positive a hospitalisation was suggested, if the result was negative an outpatient monitoring or a shortened hospitalisation was done. In maximum 2 determinations of fetal fibronectin were done. Patient-characteristics: 50 single-pregnancies and 8 multiple-pregnancies, 34 I-P, 19 II-P, 6 > II-P. Reason of fetal fibronectin analysis was in 90% labor pains, therefrom 38% with shortened cervix ( < 25 mm), in 8% shortened cervix alone and in 2% state after preterm birth alone.
Results: The goal of the fetal fibronectin test is to get useful information about a possible preterm delivery in the following 10 days. The sensitivity hereby was 50%, specificity 85.7%, PPV 8.3% and NPV 98.5%. Concerning the frequency of preterm birth ( < 36+0 week of gestation) the sensitivity was 44%, specificity 90%, PPV 63% and NPV 81%. After excluding multiple-pregnancies and iatrogenic preterm delivery the NPV was 90%. We could reduce the mean duration of hospitalisation on 3.5 days compared with an average duration of 27 days with a positive test result. Transitory positive results were caused in the majority of cases by bacterial vaginosis or cervicitis. The test result turned into negative when treating the infection.
Conclusion: Fetal fibronectin is an important and useful test in the evaluation of the preterm delivery risk. Hereby unnecessary hospitalisations and the resulting problems (costs, unpleasentness and morbidity of pregnants) can be reduced significantly.

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