Clinical Question: Does the use of fetal fibronectin in the management of preterm labor affect age at delivery or rate of interventions?
Setting: Inpatient (ward only)
Study Design: Randomized controlled trial (nonblinded)
Synopsis: Women at 23 to 34 weeks of gestation were randomized (allocation concealed) to testing with fetal fibronectin (n = 46) or without (n = 51). The test results were available within approximately one hour. The groups did not differ in median gestational age at delivery; hours spent in labor and delivery; rate of inpatient admissions; or use of corticosteroids, antibiotics, or magnesium sulfate.
Within the group tested with fetal fibronectin, significant differences were noted between patients with positive and negative test results. Women with positive results spent more hours on the antepartum ward (but not on labor and delivery), and had a higher rate of inpatient admission. The observed sensitivity and specificity of fetal fibronectin for birth within seven days were 67 percent and 79 percent, respectively. The positive predictive value for delivery within seven days was 18 percent, and the negative predictive value was 97 percent.
Bottom Line: Use of fetal fibronectin in the assessment of women presenting to labor and delivery units with symptoms of preterm labor does not affect the gestational age at delivery, frequency of use of medical interventions, length of time in labor and delivery, or rate of inpatient admissions. (Level of Evidence: 1b)