Mateus Julio, Pereira Leonardo, Baxter Jason, Berghella Vincenzo, Tolosa Jorge
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Am J Perinatol. 2007 Jun;24(6):381-5. doi: 10.1055/s-2007-981849. Epub 2007 Jun 13.
The purpose of this study is to determine the effectiveness of fetal fibronectin (FFN) compared to assessment of cervical dilation (CD) in clinical management of women with symptomatic preterm labor (PTL). Pregnant women presenting to Thomas Jefferson University Hospital between May 1, 2001 and November 30, 2002 with symptomatic PTL underwent FFN sampling and had a complete clinical evaluation including a pelvic bimanual examination. Inclusion criteria were singleton pregnancy, gestational age (GA) between 24 (0) and 33 (6) weeks, CD < 3 cm, and intact amniotic membranes. FFN samples were sent out and results were available within 4-12 hours. Clinical management including tocolysis, antenatal steroids, and hospitalization was determined based on digital CD assessment and FFN status. A dilated cervix was defined as CD > 1 cm. Ninety-three patients were included. Spontaneous preterm delivery (SPTD) at < 37 weeks occurred in 20 of 93 (21.5%) patients. Medical therapy use was significantly higher in patients with dilated cervix than in those with a closed cervix (all P values < 0.05). Tocolysis and steroid use in FFN-negative patients and FFN-positive patients were not significantly different. Furthermore, tocolytic use was higher in FFN-negative patients than in women with positive FFN (50% versus 42.1%; P = 0.53). Use of antenatal steroids was similar in patients with CD >/= 1 cm and a positive FFN (54.5% versus 47.4%; P = 0.92). Compared with FFN-negative patients, women with closed cervix were less likely to undergo interventions. In symptomatic PTL patients, CD determined clinical management more than FFN status. Overall, the use of FFN was not effective in decreasing "unnecessary" clinical interventions.
本研究的目的是确定在有症状的早产（PTL）妇女的临床管理中，与评估宫颈扩张（CD）相比，胎儿纤连蛋白（FFN）的有效性。2001年5月1日至2002年11月30日期间到托马斯·杰斐逊大学医院就诊且有症状的PTL孕妇接受了FFN采样，并进行了包括盆腔双合诊检查在内的全面临床评估。纳入标准为单胎妊娠、孕龄（GA）在24（0）至33（6）周之间、CD＜3cm且羊膜完整。FFN样本被送检，结果在4至12小时内可得。临床管理包括宫缩抑制、产前类固醇治疗和住院治疗，其决策基于数字CD评估和FFN状态。宫颈扩张定义为CD＞1cm。共纳入93例患者。93例患者中有20例（21.5%）发生了＜37周的自发性早产。宫颈扩张患者的药物治疗使用率显著高于宫颈未扩张患者（所有P值＜0.05）。FFN阴性患者和FFN阳性患者的宫缩抑制和类固醇使用情况无显著差异。此外，FFN阴性患者的宫缩抑制使用率高于FFN阳性女性（50%对42.1%；P = 0.53）。CD≥1cm且FFN阳性的患者产前类固醇的使用情况相似（54.5%对47.4%；P = 0.92）。与FFN阴性患者相比，宫颈未扩张的女性接受干预的可能性较小。在有症状的PTL患者中，CD对临床管理的决定作用大于FFN状态。总体而言，FFN的使用在减少“不必要的”临床干预方面无效。
