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Improving the screening accuracy for preterm labor- Is the combination of fetal fibronectin and cervical length in symptomatic patients a useful predictor of preterm birth? A systematic review.
MedLine Citation:
PMID:  23246314     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Our objective is to systematically review the current medical literature to assess the accuracy of the combination of fetal fibronectin (fFN) plus ultrasound assessment of cervical length (CL) as screening tools for preterm labor and prediction of preterm birth (PTB), and to compare this to the traditional clinical method of digital cervical exam. We searched PubMed and Cochrane databases without date restriction using the keywords "fibronectin" and "cervical length", limited to human studies published in English. 85 studies were identified and supplemented by one additional study found through bibliographic search. Nine studies reported the association between fFN positivity plus CL measurement with PTB in women presenting with symptomatic uterine contractions. We conducted an analytic review of the sensitivity, specificity, positive predictive value and negative predictive value of fFN plus CL for preterm birth. Further meta-analysis was not performed due to study heterogeneity, especially with respect to the range of gestational ages and variations in cut-off values for the diagnosis of short cervix. Although the clinical diagnostic methodology of preterm labor diagnosis by documenting uterine contractions plus cervical change is currently standard practice, a newer approach combining fFN and CL screening results in a higher sensitivity and PPV for preterm birth risk while maintaining high negative predictive value. We conclude that this combined screening approach yields useful information regarding short term risks which can be used to guide acute management, and effectively identifies a population at low risk in whom expensive and potentially dangerous interventions could be avoided.
Authors:
Emily A Defranco; David F Lewis; Anthony O Odibo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-11
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  -     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
Affiliation:
Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: defranco@uc.edu.
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