Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, New York, USA.
Am J Perinatol. 2012 Apr;29(4):267-72. doi: 10.1055/s-0031-1285827. Epub 2011 Aug 4.
To estimate the risk of preterm birth in asymptomatic women with twin pregnancies with a normal cervical length (CL) and a positive fetal fibronectin (fFN), we reviewed a retrospective cohort of twin pregnancies delivered in our practice from 2005 to 2010. Patients were screened from 22 to 32 weeks with CL and fFN at 2- to 4-week intervals. We examined 244 patients with twin pregnancies and a normal CL (>25 mm) between 22 and 32 weeks and compared outcomes based on the fFN result. Fourteen (5.7%) patients had a positive fFN and 230 (94.3%) patients had a negative fFN. Positive fFN was associated with an increased the risk of spontaneous preterm birth < 37 weeks (85.7% versus 38.3%, p = 0.001), < 35 weeks (50% versus 11.8%, p < 0.001), < 34 weeks (35.7% versus 6.9%, p < 0.001), and < 32 weeks (21.4% versus 2.2%, p < 0.001). On adjusted analysis, a positive fFN was independently associated with preterm birth < 32 weeks (odds ratio 6.8, 95% confidence interval 1.42, 32.2) and gestational age at delivery (p = 0.001). In the setting of a normal CL, a positive fFN is significantly associated with preterm birth in asymptomatic twin pregnancies. Contingency model screening of fFN in asymptomatic twin pregnancies solely based on CL evaluation may fail to identify a cohort of at-risk patients.
为了评估宫颈长度（CL）正常且胎儿纤维连接蛋白（fFN）阳性的无症状双胎妊娠孕妇早产的风险，我们回顾了 2005 年至 2010 年在我们诊所分娩的双胎妊娠回顾性队列。患者在 22 至 32 周时进行 CL 和 fFN 筛查，间隔 2-4 周。我们检查了 244 例 22 至 32 周 CL 正常（>25mm）的双胎妊娠患者，并根据 fFN 结果比较了结局。14 例（5.7%）患者 fFN 阳性，230 例（94.3%）患者 fFN 阴性。fFN 阳性与自发性早产<37 周的风险增加相关（85.7%对 38.3%，p=0.001），<35 周（50%对 11.8%，p<0.001），<34 周（35.7%对 6.9%，p<0.001），<32 周（21.4%对 2.2%，p<0.001）。在调整分析中，fFN 阳性与早产<32 周独立相关（比值比 6.8，95%置信区间 1.42，32.2）和分娩时的孕龄（p=0.001）。在 CL 正常的情况下，fFN 阳性与无症状双胎妊娠早产显著相关。仅基于 CL 评估的无症状双胎妊娠 fFN 偶然模型筛查可能无法识别高危患者群体。
