Risk Assessment for Preterm Delivery using the Fetal Fibronectin Test Associated with the Measurement of Uterine Cervix Length in Symptomatic Pregnant Women

Tadeu Rodriguez de Carvalho Pinheiro Filho; Vanessa Rocha Pessoa; Thaisa de Sousa Lima; Marcela Melo de Castro; José Juvenal Linhares

doi:10.1055/s-0038-1667185

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, Table of Contents

CC BY 4.0 · Rev Bras Ginecol Obstet 2018; 40(09): 507-512
DOI: 10.1055/s-0038-1667185

Original Article

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Risk Assessment for Preterm Delivery using the Fetal Fibronectin Test Associated with the Measurement of Uterine Cervix Length in Symptomatic Pregnant Women

Avaliação do risco para parto pré-termo utilizando o teste da fibronectina fetal, associado à medida de comprimento de colo uterino, em gestantes sintomáticas

Tadeu Rodriguez de Carvalho Pinheiro Filho

¹Gynecology and Obstetrics Residency Program, Santa Casa de Misericórdia de Sobral, Sobral, CE, Brazil

,

Vanessa Rocha Pessoa

²Faculty of Medicine, Universidade Federal do Ceará, Sobral, CE, Brazil

,

Thaisa de Sousa Lima

²Faculty of Medicine, Universidade Federal do Ceará, Sobral, CE, Brazil

,

Marcela Melo de Castro

²Faculty of Medicine, Universidade Federal do Ceará, Sobral, CE, Brazil

,

José Juvenal Linhares

¹Gynecology and Obstetrics Residency Program, Santa Casa de Misericórdia de Sobral, Sobral, CE, Brazil

²Faculty of Medicine, Universidade Federal do Ceará, Sobral, CE, Brazil

› Author Affiliations

Abstract

Objective To analyze the use of the measurement of uterine cervix length (MUCL) and the fetal fibronectin (fFN) rapid test as predictors of preterm delivery (PTD) in symptomatic pregnant women assisted at the Santa Casa de Misericórdia de Sobral Maternity Hospital.

Methods This was a prospective and analytic study involving 53 parturients assisted between September of 2015 and July of 2016; the participants were between 24 and 34 weeks of gestational age (GA) and presented complaints related to preterm labor (PTL) prodromes. Vaginal secretion was collected for fFN testing, and the MUCL was obtained via transvaginal ultrasonography.

Results A total of 58.49% of the subjects showed MUCL < 25 mm, and 41.51% were positive in the fFN rapid test. A total of 48 patients were followed-up until their delivery date, and 54.17% resulted in PTL. The relative risk (RR) for PTD in patients with MUCL < 25 mm was 1.83 (p = 0.09, 0.99–3.36, 95% confidence interval [CI]), with a mean time before delivery of 2.98 weeks. Based on fFN positive results, the RR was 3.50 (p = 0.002, 1.39–8.79, 95%CI) and the mean time until delivery was 1.94 weeks. The RR was 2.70 (p = 0.002, 1.08–6.72, 95%CI) when both tests were used. The RR of PTD within 48 hours, and 7 and 14 days were, respectively, 1.30 (p = 0.11, 95% CI 1.02–1.67), 1.43 (p = 0.12, 95% CI % 0.99–2.06), and 2.03 (p = 0.008, 95% CI 1.26–3.27), when based on the MUCL, and 1.75 (p = 0.0006, 95% CI 1.20–2.53), 2.88 (p = 0.0001, 95% CI, 1.57–5.31), and 3.57 (p = 0.0002, 95% CI 1.63–7.81) when based on positive fFN results. The RR at 48 hours and 7 and 14 days considering both tests was 1.74 (p = 0.0001, 95% CI 1.14–2.64), 2.22 (p = 0.0001, 95% CI 1.22–4.04), and 2.76 (p = 0.0002, 95% CI 1.27–5.96), respectively.

Conclusion In symptomatic pregnant women, we concluded that the MUCL < 25 mm associated with positive fFN rapid test indicate increased the risk for PTD. Further studies with larger sample sizes could contribute in supporting the results presented in the current study.

Resumo

Objetivo Analisar a utilização da medida do comprimento do colo uterino (MCCU), e do teste da fibronectina fetal (FNf) como preditores do trabalho de parto pré-termo (PPT), em gestantes sintomáticas, atendidas na Maternidade da Santa Casa de Misericórdia de Sobral.

Métodos Foi realizado um estudo prospectivo e analítico, envolvendo 53 parturientes atendidas no período de setembro de 2015 a julho de 2016, com idade gestacional (IG) entre 24 e 34 semanas que tiveram queixas relacionadas a pródromos de trabalho de parto prematuro (TPP), sendo realizada coleta de secreção vaginal para FNf e MCCU por via ultrassonográfica transvaginal.

Resultados Um total de 58,49% das pacientes tinham MCCU < 25 mm, e 41,51% tiveram teste rápido de fFN positivo. Foi feito o acompanhamento de 48 pacientes, com 54,17% de PPTs. O risco relativo (RR) para PPT com MCCU < 25 mm foi de 1,83 (p = 0,09, 0,99–3,36, intervalo de confiança [IC] 95%), com média de tempo até o parto de 2,98 semanas. Para fFN, o RR foi de 3.50 (p = 0.002, 1.39–8.79, IC 95%) e a média até o parto foi de 1,94 semanas. Quando os dois testes foram positivos, o RR foi de 2,70 (1,08–6,72). Para a MCCU, o RR para PPT em 48 horas, 7 e 14 dias foram 1,30 (p = 0.11, 95% IC 1.02–1.67), 1,43 (p = 0.12, 95% CI % 0.99–2.06) e 2,03 (p = 0.008, 95% IC 1.26–3.27), respectivamente. Para FNf, em 48 horas, 7 e 14 dias foi de 1,75 (p = 0.0006, 95% IC 1.20–2.53, 2,88 (p = 0.0001, 95% IC, 1.57–5.31) e 3,57 (p = 0.0002, 95% IC 1.63–7.81) respectivamente. Com os dois testes, o RR em 48 horas, 7 e 14 dias foi 1,74 (p = 0.0001, 95%IC 1.14–2.64), 2,22 (p = 0.0001, 95% IC 1.22–4.04) e 2,76 (p = 0.0002, 95% IC 1.27–5.96) respectivamente.

Conclusão Em mulheres grávidas sintomáticas, concluímos que a MCCU < 25 mm e o teste rápido de FNf positivo indicam aumento do risco de PPT. Outros estudos com tamanhos de amostra maiores podem contribuir para apoiar os resultados apresentados no presente estudo.

Keywords

cervical length measurement - fibronectin - pregnancy - preterm labor - risk

Palavras-chave

medida do comprimento cervical - fibronectina - gravidez - trabalho de parto prematuro - risco

Full Text

References

References
1 Figo Working Group On Best Practice In Maternal-Fetal Medicine; International Federation of Gynecology and Obstetrics. Best practice in maternal-fetal medicine. Int J Gynaecol Obstet 2015; 128 (01) 80-82 . Doi: 10.1016/j.ijgo.2014.10.011
2 Iams JD, Romero R, Culhane JF, Goldenberg RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet 2008; 371 (9607): 164-175 . Doi: 10.1016/S0140-6736(08)60108-7
3 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84 . Doi: 10.1016/S0140-6736(08)60074-4
4 Souza RT, Cecatti JG, Passini Jr R. , et al; Brazilian Multicenter Study on Preterm Birth study group. The burden of provider-initiated preterm birth and associated factors: evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP). PLoS One 2016; 11 (02) e0148244 . Doi: 10.1371/journal.pone.0148244
5 Gao L, Zhang JP, Chen H. , et al. Fetal fibronectin detection for preterm birth prediction. Genet Mol Res 2014; 13 (01) 1323-1328 . Doi: 10.4238/2014.February.28.4
6 Bittar RE, Zugaib M. [Risk predictors for preterm birth]. Rev Bras Ginecol Obstet 2009; 31 (04) 203-209 . Doi: 10.1590/S0100-72032009000400008
7 Rades E, Bittar RE, Zugaib M. Direct determinants of elective preterm birth and neonatal results. Rev Bras Ginecol Obstet 2004; 26: 655-662 . Doi: 10.1590/S0100-72032004000800010
8 Oliveira TA, Carvalho CM, Souza E. , et al. Evaluation of risk for preterm delivery by fetal fibronectin test and measurement of uterine cervix. Rev Bras Ginecol Obstet 2000; 22: 633-639 . Doi: 10.1590/S0100-72032000001000006
9 Bezerra LC, Oliveira SM, Latorre MR. Prevalência e fatores associados à prematuridade entre gestantes submetidas à inibição de trabalho de parto prematuro. Rev Bras Saude Mater Infant 2006; 6: 223-229 . Doi: 10.1590/S1519-38292006000200010
10 Zalar Jr RW. Early cervical length, preterm prelabor and gestational age at delivery. Is there a relationship?. J Reprod Med 1998; 43 (12) 1027-1033
11 Carvalho MH, Bittar RE, Gonzales M, Brizot ML, Zugaib M. Risk assessment for spontaneous preterm delivery according to cervical length in the first and second trimesters of pregnancy. Rev Bras Ginecol Obstet 2002; 24: 463-468 . Doi: 10.1590/S0100-72032002000700006
12 Dória MT, Spautz CC. Trabalho de parto prematuro predição e prevenção. Femina 2011; 9: 443-449
13 Yamasaki AA, Bittar RE, Fonseca ES, Martinelli S, Sasaki S, Zugaib M. Prevention of preterm birth: use of digital examination and transvaginal ultrasonography. Rev Bras Ginecol Obstet 1998; 20: 350-356 . Doi: 10.1590/S0100-72031998000600008
14 Iams JD, Goldenberg RL, Meis PJ. , et al; National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 1996; 334 (09) 567-572 . Doi: 10.1056/NEJM199602293340904
15 Tanvir GS, Ghose S, Samal S, Armugam S, Parida P. Measurement of cervical biometry using transvaginal ultrasonography in predicting preterm labor. J Nat Sci Biol Med 2014; 5 (02) 369-372 . Doi: 10.4103/0976-9668.136189
16 To MS, Skentou C, Liao AW, Cacho A, Nicolaides KH. Cervical length and funneling at 23 weeks of gestation in the prediction of spontaneous early preterm delivery. Ultrasound Obstet Gynecol 2001; 18 (03) 200-203 . Doi: 10.1046/j.1469-0705.2001.00437.x
17 Berghella V, Saccone G. Fetal fibronectin testing for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2016; 215 (04) 431-438 . Doi: 10.1016/j.ajog.2016.04.038
18 Bruijn MM, Kamphuis EI, Hoesli IM. , et al. The predictive value of quantitative fibronectin testing in combination with cervical length measurement in symptomatic women. Am J Obstet Gynecol 2016; 215 (06) 793.e1-793.e8 . Doi: 10.1016/j.ajog.2016.08.012
19 Bruijn M, Vis JY, Wilms FF. , et al. Quantitative fetal fibronectin testing in combination with cervical length measurement in the prediction of spontaneous preterm delivery in symptomatic women. BJOG 2016; 123 (12) 1965-1971 . Doi: 10.1111/1471-0528.13752
20 Gomez R, Romero R, Medina L. , et al. Cervicovaginal fibronectin improves the prediction of preterm delivery based on sonographic cervical length in patients with preterm uterine contractions and intact membranes. Am J Obstet Gynecol 2005; 192 (02) 350-359 . Doi: 10.1016/j.ajog.2004.09.034
21 Deshpande SN, van Asselt AD, Tomini F. , et al. Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis. Health Technol Assess 2013; 17 (40) 1-138 . Doi: 10.3310/hta17400
22 Magro-Malosso E, Seravalli V, Cozzolino M, Spitaleri M, Susini T, Di Tommaso M. Prediction of preterm delivery by fetal fibronectin in symptomatic and asymptomatic women with cervical length ≤20 mm. J Matern Fetal Neonatal Med 2017; 30 (03) 294-297 . Doi: 10.3109/14767058.2016.1171309
23 van Baaren GJ, Vis JY, Grobman WA, Bossuyt PM, Opmeer BC, Mol BW. Cost-effectiveness analysis of cervical length measurement and fibronectin testing in women with threatened preterm labor. Am J Obstet Gynecol 2013; 209 (05) 436.e1-436.e8 . Doi: 10.1016/j.ajog.2013.06.029
24 Hadži-Legal M, Markova AD, Stefanovic M, Tanturovski M. Combination of selected biochemical markers and cervical length in the prediction of impending preterm delivery in symptomatic patients. Clin Exp Obstet Gynecol 2016; 43 (01) 154-160 . Doi: 10.12891/ceog2046.2016
25 Healey GK, Macdonald WA, Grzybowski S, Nevin R, Kornelsen J, Hogg WE. Exploring fetal fibronectin testing as a predictor of labour onset: In parturient women from isolated communities. Can Fam Physician 2018; 64 (03) e108-e114 [REMOVED HYPERLINK FIELD]