November 2003 · Vol. 15, No. 11Is routine sampling of fetal fibronectin justified?
This test does help identify women likely to deliver early. To warrant universal use, however, a screening test should meet 5 conditions—including availability of an effective intervention.
GEORGE
A.
MACONES,
MD;
ALISON
CAHILL,
MDDr. Macones is associate professor of obstetrics, gynecology, and epidemiology; director, division of maternal-fetal medicine; and director, obstetrics, University of Pennsylvania Health System, Philadelphia. Dr. Cahill is an instructor, department of obstetrics and gynecology, University of Pennsylvania Health System, Philadelphia.
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KEY POINTS
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Spontaneous preterm birth is associated with elevated cervicovaginal fetal fibronectin levels, especially in women who deliver at an early gestational age.
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A recent study suggests that antibiotic therapy in women with a positive fetal fibronectin screening test does not reduce the incidence of spontaneous preterm birth or improve neonatal outcomes.
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Fetal fibronectin cannot be recommended as a screening test for preterm birth.
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Routine fetal fibronectin sampling to identify women at risk for preterm delivery seems justified, studies suggest. Closer scrutiny, however, reveals the absence of an element crucial to successful screening: an effective intervention.
This article reviews the landmark studies of fetal fibronectin testing, as well as findings of a recent multicenter double-blind, place-bo-controlled trial of antibiotic therapy.
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