| Prediction of Labor in Term Pregnancy Using Fetal Fibronectin and Transvaginal Ultrasonography. |
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S Y Lee, Y Lee, J Y Hwang, D Y Chung, J S Lee, J C Shin, C Y Kim, S P Kim |
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| Abstract |
OBJECTIVE
To predict the onset of labor in term pregnancy, we performed digital examination of cervix, transvaginal ultrasonographic evaluation of the uterine cervix, and fetal fibronectin in cervicovaginal secretions in women after 37 complete weeks of gestation. Study design: Total 67 prmiparous or multiparous women were divided into two groups based on the duration between evaluation and onset of labor; Group 1 (n=46), within seven days; Group 2 (n=21), beyond seven days, retrospectively. Bishop score was assessed by digital vaginal examination. Then biometric analysis of uterine cervix (endocervical length, presence of funneling, funnel length, funnel width and cervical index) was done by trasvaginal ultrasonography. The cervicovaginal fetal fibronectin was measured quantitatively by fetal fibronectin immunoassay (Adeza Biomedical, U.S.A.). The efficacy of these method were analyzed with Pearson chi-square test, receiver-operator characteristic curve, and multiple logistic regression test. RESULTS: 1. There were no significant differences in maternal age, parity, gestational age and birth weight between two groups. 2. Group 1 showed significantly shorter endocervical length (Group 1: Group 2=2.24+/-0.86 cm: 2.78+/-0.66 cm, p=0.012), higher value of cervical index (1.08+/-0.86: 0.55+/-0.25, p=0.008) and higher level of fetal fibronectin( 103.23+/-14 ng/ml: 9.28 +/-36 ng/ml, p=0.003) than those of group 2. 3. Receiver-operator characteristic curve analysis showed that a level of fetal fibronectin in cervicovaginal secretion > or =60 ng/ml, cervical index > or =0.82 and endocervical length <2.51 cm had the diagnostic performance in predicting group 1. Fetal fibronectin level in cervicovaginal secretion > or =60 ng/ml showed the highst diagnostic index in predicting the onset of labor within 7 days (p=0.0003, odds ratio=104.67). CONCLUSION: From these results, the assay of fetal fibronectin in cervicovaginal secretions is more accurate than ultrasonographic examination of the uterine cervix in the prediction of the onset of term labor and the fetal fibronectin assay may improve the diagnostic efficiency to identify a subgroup of patients who may require aggressive treatment. |
| Key Words:
Fetal fibronectin, Transvaginal sonography, Cervical index, Bishop score, Term pregnancy |
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