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Re: (fibronectin, etc.)From: Mats Bergstrom (matsb@sos.sll.se)Wed Mar 20 04:47:49 1996
On Tue, 19 Mar 1996, Paul Prior MD wrote:
> a clinically significant use for such measurements. I don't hold much Fibronectin has a place in the second and early third trimester, according to several studies, i.e. a negative test is strongly suggesting that (irregular) contractions are unharmful and don't need treatment. It's benefits at term are more controversial. An interesting approach was just published (Nisell H. et al. Assessment of fetal fibronectin in cervical secretion in cases of equivocal rupture of the membranes at term. Acta Obstet Gynecol Scand 1996;75:132-134). They did not bother to investigate if a "true" rupture had occurred or not (comparing other methods - where none would be the perfect reference method anyway) but treated all equivocal ruptures (defined by no clearly visible amniotic fluid at speculum examination) the same, regardless of the outcome of the fibronectin test (positive nI, negative ng). The 'treatment' consisted of sending the patients home to await spontaneous labor. The median time to delivery was 80 hours for the negative, 64 hours for the positive ones (not significant, p=0.28). There was no difference in the rates of complicated delivery or fetal distress. Goodbye fibronectin at term? I hope somebody will have the time to repeat such a study with the IGFBP-1 test that they are trying to sell to us now (Lockwood CJ et al. Fetal membrane rupture is associated with the presence of insulin-like growth factor-binding protein-1 in vaginal secretions. Am J Obstet Gynecol 1994;171:146-150).
-- Mats Bergstrom, MD Ob Gyn South Hospital Stockholm
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