Cochrane for Clinicians

Putting Evidence into Practice

Potential of Fetal Fibronectin Testing to Prevent Preterm Birth

 

Am Fam Physician. 2020 Jun 1;101(11):652-653.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does testing for fetal fibronectin in patients with signs and symptoms of preterm labor help to prevent preterm birth (i.e., birth before 37 weeks' gestation)?

Evidence-Based Answer

Fetal fibronectin testing may reduce preterm birth, although the evidence is not strong enough to recommend regular testing. Knowing the results of fetal fibronectin testing does not lead to a reduction in secondary outcomes such as preterm birth before 34 weeks' gestation, admission to the neonatal intensive care unit, or perinatal death.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Preterm birth affects about one in 10 births in the United States and is the second most common cause of infant mortality.2,3 Tools to identify the risk of preterm birth are limited. One potential marker, fetal fibronectin, is a glycoprotein produced by amniocytes and cytotrophoblasts and is found at the maternal-fetal interface. It is believed that fetal fibronectin keeps the amniotic sac attached to the uterine lining. In practice, a positive test result indicates that the mother is at increased risk of preterm birth during the ensuing seven days.4 This review focuses on the potential of fetal fibronectin testing to prevent preterm birth in patients with signs and symptoms of preterm labor.

The authors assessed six trials with 546 women who had a singleton pregnancy and signs and symptoms of preterm labor at 23 weeks' to 34 6/7 weeks' gestation.1 Only studies evaluating outcomes based solely on fetal fibronectin test results were included. Interventions based on additional methods of preterm delivery prediction, such as cervical length measurement, were not included. One trial was completed in the United Kingdom, and five were completed in the United States.

Management of preterm labor based on fetal fibronectin results did not reduce the overall rate of preterm birth (relative risk = 0.72; 95% CI, 0.52 to 1.01). However, when

Author disclosure: No relevant financial affiliations.

References

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1. Berghella V, Saccone G. Fetal fibronectin testing for reducing the risk of preterm birth. Cochrane Database Syst Rev. 2019;(7):CD006843....

2. Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2017. NCHS Data Brief. 2018;(318):1–8.

3. Centers for Disease Control and Prevention. Infant mortality. March 27, 2019. Accessed September 5, 2019. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

4. 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.

5. American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics. Management of preterm labor. ACOG practice bulletin no. 171. Obstet Gynecol. 2016;128(4):e155–e164.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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