Díaz Jeaneth, Chedraui Peter, Hidalgo Luis, Medina Marcela
Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador.
J Matern Fetal Neonatal Med. 2009 Feb;22(2):89-93. doi: 10.1080/14767050802464551.
Pre-term birth is a world wide health problem, and although fetal fibronectin (fFN) testing has proven its clinical utility in developed countries, this remains to be determined in the developing world.
To evaluate the clinical utility of fFN in predicting pre-term birth in a low socio-economic, non-profit hospital setting.
In this observational study, pregnant women < 37 completed weeks with symptoms suggestive of threatened pre-term labour (painful regular contractions and cervical modifications) were tested with the fFN test, admitted for management and subsequently followed up every 2 weeks until the end of gestation. Delivery rates <35 and <37 weeks and within 7, 14 and 21 days were compared among women with positive and negative results.
During the study period, 180 gravids were tested for fFN [52 positives (28.9%) and 128 negatives (71.1%)]. In the positive fFN group, the admission-to-delivery interval was significantly shorter, whereas delivery rates before 35 and 37 weeks and within 7, 14 and 21 days were found to be higher. Neonates delivered from positive fFN women had lower weight and gestational age as well as higher rates of adverse neonatal outcomes and admissions to the intensive care unit. Finally, fFN testing was useful in predicting delivery at less than 37 and 35 weeks (sensitivity: 76, 100%; specificity: 89.2, 76.2%; positive predictive value: 73.1, 23.1%; negative predictive value: 90.6, 100%, respectively) and within 7, 14 and 21 days (sensitivity: 75, 66 and 65.6%; specificity: 78.2, 86.6 and 91.4%; positive predictive value: 34.6, 67.3 and 80.8%; negative predictive value 95.3, 85.9 and 82.8%, respectively).
In this low-income healthcare scenario, testing for fFN was effective in assessing the risk of pre-term birth; we propose that testing be implemented as a hospital policy suggesting that negative resulting women be managed in an ambulatory fashion.
早产是一个全球性的健康问题，尽管胎儿纤连蛋白（fFN）检测在发达国家已证明其临床效用，但在发展中国家仍有待确定。
评估fFN在社会经济水平较低的非营利性医院环境中预测早产的临床效用。
在这项观察性研究中，对孕周小于37周且有早产迹象（规律宫缩疼痛和宫颈改变）的孕妇进行fFN检测，收治入院并进行管理，随后每2周随访一次直至妊娠结束。比较fFN检测结果为阳性和阴性的女性在35周和37周前以及7天、14天和21天内的分娩率。
在研究期间，180名孕妇接受了fFN检测[52例阳性（28.9%），128例阴性（71.1%）]。在fFN检测阳性组中，入院至分娩的间隔明显更短，而35周和37周前以及7天、14天和21天内的分娩率更高。fFN检测阳性的女性所分娩的新生儿体重和孕周较低，不良新生儿结局和入住重症监护病房的发生率更高。最后，fFN检测在预测37周和35周前分娩方面是有用的（敏感性分别为76%、100%；特异性分别为89.2%、76.2%；阳性预测值分别为73.1%、23.1%；阴性预测值分别为90.6%、100%），以及在7天、14天和21天内分娩方面（敏感性分别为75%、66%和65.6%；特异性分别为78.2%、86.6%和91.4%；阳性预测值分别为34.6%、67.3%和80.8%；阴性预测值分别为95.3%、85.9%和82.8%）。
在这种低收入医疗环境中，fFN检测在评估早产风险方面是有效的；我们建议将该检测作为一项医院政策实施，即建议检测结果为阴性的女性采用门诊方式管理。
