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What Tests Are Best for Predicting Preterm Delivery?

Summary and Comment |
June 5, 2014

What Tests Are Best for Predicting Preterm Delivery?

  1. Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

The combination of cervical length plus fetal fibronectin was most accurate.

  1. Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

Identifying women at risk for spontaneous preterm delivery who are not likely to give birth imminently would help avoid unnecessary intervention. Dutch researchers conducted a nationwide prospective cohort study to estimate the combined accuracy of cervical length plus fetal fibronectin to predict risk for impending delivery in 665 women (103 with multiple gestations) who presented with signs of preterm labor between 24 and 34 weeks' gestation (mean, 29 weeks). Models were developed using the two tests alone or combined to stratify women into low- and high-risk groups based on a 5% threshold of risk for delivery within 7 days.

Median cervical length at study entry was 25 mm; fetal fibronectin was negative in 55% of participants. A total of 80 women delivered within 7 days. The most accurate model included both cervical length and fetal fibronectin as predictors of risk for preterm delivery.

Comment

The authors propose a clinical decision rule whereby women with cervical length ≥30 mm are at low risk for preterm delivery, those with length ≤15 mm are at high risk, and those with length between 15 and 30 mm have risk degree contingent on fibronectin test results (positive fibronectin connotes high risk, and negative fibronectin signifies low risk). They note that, compared with cervical length alone as an indicator of preterm birth, combining cervical length and fetal fibronectin could reduce the likelihood of referrals and admissions to perinatal centers by 10%. This modification of the workup for preterm labor is now being incorporated into many obstetric triage centers where cervical length assessment is being taught as an adjunct to fetal fibronectin. However, larger studies are needed before we can use this model to fully evaluate risk in twin gestations.

  • Disclosures for Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC at time of publication Editorial boards Journal of Perinatal and Neonatal Nursing

Citation(s):

Reader Comments (1)

Richard R. Thornton,M.D. Physician, Retired Obstetrician

A useful addition to history and vaginal examination to guide those who care for pregnant women. I presume that the cervical measurements were made with Ultrasound.

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