blind ffn article
From: RModugno@aol.com
Thu Apr 7 19:42:30 2005
Obstetrics & Gynecology 2005;105:285-289
© 2005 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH
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"Blind" Vaginal Fetal Fibronectin as a Predictor of Spontaneous Preterm
Delivery
<NOBR>Ashley S. Roman, M*, , <NOBR>Nikki Kokl*, , <NOBR>Michael J. Paid, ,
<NOBR>Jeanine Mulhol*, , <NOBR>Mortimer L* and and <NOBR>Andrei Reb*
>From the *Department of Obstetrics and Gynecology, New York University
School of Medicine, New York, New York; and Department of Obstetrics and
Gynecology, Yale University School of Medicine, New Haven, Connecticut.
Address reprint requests to: Ashley S. Roman, MD, MPH, 550 First Avenue, NB
9E2, New York, NY 10016; e-mail: _achapinsmith@aol.com_
(mailto:achapinsmith@aol.com) .
OBJECTIVE: To assess the accuracy of vaginal fetal fibronectin sampling
without use of a sterile speculum examination as a screening test for predicting
spontaneous preterm birth.
METHODS: A historical cohort of patients who were followed up with serial
fetal fibronectin testing between 1998 and 2001 was identified. All patients were
considered to be at high risk for preterm delivery and were screened with
fetal fibronectin testing without using a speculum at 2- to 3-week intervals
from 22 weeks to 32 weeks of gestation. Charts were reviewed for fetal
fibronectin results and pregnancy outcome data. Groups were compared using 2
analysis or Fisher exact test with significance defined as P < .05.
RESULTS: A total of 1,396 fetal fibronectin tests from 416 pregnancies were
performed via the "blind" sampling technique. Overall, 24.9% of pregnancies
delivered spontaneously before 37 weeks; 9.1% delivered spontaneously before 34
weeks. For delivery before 34 weeks of gestation, the test had a sensitivity
of 44.7%, a specificity of 88.4%, a positive predictive value of 27.9%, and a
negative predictive value of 94.1%. For delivery within 14 and 21 days of a
single fetal fibronectin assessment, the test had a sensitivity of 52% and
45.5%, a specificity of 94.5% and 94.9%, a positive predictive value of 14.6%
and 22.5%, and a negative predictive value of 99.1% and 98.2%, respectively.
CONCLUSION: "Blind" vaginal fetal fibronectin sampling has high negative
predictive values and specificities in predicting spontaneous preterm birth.
LEVEL OF EVIDENCE: II-2
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