Roman Ashley S, Rebarber Andrei, Lipkind Heather, Mulholland Jeanine, Minior Victoria, Roshan Daniel
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY USA.
Am J Obstet Gynecol. 2004 Jan;190(1):142-6. doi: 10.1016/j.ajog.2003.07.027.
The study was undertaken to assess the validity of vaginal fetal fibronectin assay as a screening test for spontaneous preterm delivery in asymptomatic patients who have undergone multifetal pregnancy reduction (MFPR).
A historic cohort of 63 patients who underwent MFPR between 10 and 14 weeks of gestation was identified. All patients underwent serial vaginal fetal fibronectin sampling every 2 to 3 weeks from 22 weeks of gestation until delivery or 32 weeks of gestation. The fetal fibronectin concentration was measured by enzyme-linked immunosorbent assay, with 50 ng/mL or greater indicating a positive result. Charts were reviewed for fetal fibronectin results and pregnancy outcome data. Groups were compared by use of Fisher exact test.
There were 13 singleton and 50 twin gestations after MFPR. A median of 4 fetal fibronectin assays were performed per patient. A total of 234 fetal fibronectin assays were performed with 222 (94.9%) negative results and 12 (5.1%) positive results. Overall, 41.3% of gestations were delivered spontaneously before 37 weeks; 7.9% were delivered before 34 weeks. The mean interval between tests was 17.8 days (+/-7.2 days). For delivery within 2 and 3 weeks of a single test, fetal fibronectin had a sensitivity of 66.7% and 50%, a specificity of 95.7% and 96.1%, a positive predictive value of 16.7% and 25%, and a negative predictive value of 99.5% and 98.6%, respectively.
The fetal fibronectin test has similar validity to predict spontaneous preterm delivery in these high-risk pregnancies as in previously published cohorts.
本研究旨在评估阴道胎儿纤连蛋白检测作为无症状多胎妊娠减胎术（MFPR）患者自发性早产筛查试验的有效性。
确定了一组63例在妊娠10至14周接受MFPR的患者的历史队列。所有患者从妊娠22周开始至分娩或妊娠32周，每2至3周进行一次连续的阴道胎儿纤连蛋白采样。采用酶联免疫吸附测定法测量胎儿纤连蛋白浓度，50 ng/mL或更高为阳性结果。查阅病历以获取胎儿纤连蛋白检测结果和妊娠结局数据。采用Fisher精确检验对各组进行比较。
MFPR后有13例单胎妊娠和50例双胎妊娠。每位患者平均进行4次胎儿纤连蛋白检测。共进行了234次胎儿纤连蛋白检测，其中222次（94.9%）为阴性结果，12次（5.1%）为阳性结果。总体而言，41.3%的妊娠在37周前自发分娩；7.9%在34周前分娩。两次检测之间的平均间隔为17.8天（±7.2天）。对于在单次检测后2周和3周内分娩的情况，胎儿纤连蛋白的敏感性分别为66.7%和50%，特异性分别为95.7%和96.1%，阳性预测值分别为16.7%和25%，阴性预测值分别为99.5%和98.6%。
胎儿纤连蛋白检测在预测这些高危妊娠的自发性早产方面具有与先前发表的队列相似的有效性。
