Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA.
Am J Obstet Gynecol MFM. 2020 Nov;2(4):100170. doi: 10.1016/j.ajogmf.2020.100170. Epub 2020 Jul 14.
This study aimed to determine whether recent cervical manipulation via transvaginal ultrasound, sterile vaginal examination, or coitus affects the accuracy of fetal fibronectin results.
An electronic search was performed in PubMed, Scopus, Embase, Ovid MEDLINE, ClinicalTrials.gov, Cochrane Library, and CINAHL using a combination of pertinent key words from inception to June 2019.
We included all observational studies that provided individual-level data on fetal fibronectin results after recent transvaginal ultrasound, sterile vaginal examination, or coitus.
Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Individual participant data from the included studies were pooled for each intervention. The primary outcome was agreement between pre- and postmanipulation swabs, estimated using proportion agreement and kappa statistics with 95% confidence intervals. Secondary outcomes included frequency in which the fetal fibronectin result changed after cervical manipulation and percentage of discordant pairs. Baseline fetal fibronectin swabs were not obtained in studies examining coitus; therefore, the results of these articles were examined separately. Outcome data were combined to estimate the relative risk of a positive qualitative fetal fibronectin result after coitus and differences in the concentration of quantitative fetal fibronectin.
Of 807 studies identified, 6 were included. Three studies assessed the effect of transvaginal ultrasound (n=346 specimen pairs), 2 of sterile vaginal examination (n=122 specimen pairs), and 2 of coitus (n=262 specimen pairs) on fetal fibronectin results, with 1 study assessing the effect of more than 1 intervention. The proportion agreement between specimen pairs before and after transvaginal ultrasound and sterile vaginal examination was 93.4% (kappa, 0.69; 95% confidence interval, 0.57-0.81) and 88.5% (kappa, 0.69; 95% confidence interval, 0.54-0.84), respectively. For both transvaginal ultrasound and sterile vaginal examination, discordance with a positive preintervention fetal fibronectin and negative postintervention fetal fibronectin occurred more frequently than the converse. Patients reporting coitus within 24 to 48 hours were more likely to have a positive fetal fibronectin result than controls (39.7% vs 7.1%; relative risk, 5.6; 95% confidence interval, 3.0-10.6).
Cervical manipulation via transvaginal ultrasound or sterile vaginal examination does not significantly affect fetal fibronectin results; therefore, its use after these exposures is clinically acceptable. Conversely, the use of fetal fibronectin in the setting of recent coitus should continue to be discouraged.
本研究旨在确定近期经阴道超声、无菌阴道检查或性交后进行的颈椎推拿是否会影响胎儿纤维连接蛋白检测结果的准确性。
我们在 PubMed、Scopus、Embase、Ovid MEDLINE、ClinicalTrials.gov、Cochrane 图书馆和 CINAHL 中进行了电子检索，使用了从研究开始到 2019 年 6 月的相关关键词组合。
我们纳入了所有提供近期经阴道超声、无菌阴道检查或性交后胎儿纤维连接蛋白检测结果的个体水平数据的观察性研究。
我们使用纽卡斯尔-渥太华质量评估量表对队列研究进行了评估。对纳入研究中的每个干预措施的个体参与者数据进行了汇总。主要结局是使用比例一致性和kappa 统计量（95%置信区间）估计经阴道超声或无菌阴道检查前后拭子之间的一致性。次要结局包括宫颈操作后胎儿纤维连接蛋白结果改变的频率和不一致对的百分比。在研究性交的研究中没有获得基线胎儿纤维连接蛋白拭子；因此，分别检查了这些文章的结果。性交后，阳性定性胎儿纤维连接蛋白结果的相对风险和定量胎儿纤维连接蛋白浓度的差异，通过对 6 项研究（346 对标本）的评估来估计。
在 807 项研究中，有 6 项研究被纳入。3 项研究评估了经阴道超声（n=346 对标本）、2 项研究评估了无菌阴道检查（n=122 对标本）和 2 项研究评估了性交（n=262 对标本）对胎儿纤维连接蛋白检测结果的影响，其中 1 项研究评估了超过 1 项干预措施的影响。经阴道超声和无菌阴道检查前后标本之间的比例一致性分别为 93.4%（kappa，0.69；95%置信区间，0.57-0.81）和 88.5%（kappa，0.69；95%置信区间，0.54-0.84）。对于经阴道超声和无菌阴道检查，与阳性预处理胎儿纤维连接蛋白和阴性后处理胎儿纤维连接蛋白不一致的情况比相反的情况更常见。在 24 至 48 小时内报告性交的患者比对照组更有可能有阳性胎儿纤维连接蛋白检测结果（39.7% vs 7.1%；相对风险，5.6；95%置信区间，3.0-10.6）。
经阴道超声或无菌阴道检查后的颈椎推拿不会显著影响胎儿纤维连接蛋白检测结果，因此在这些检查后进行临床检查是可以接受的。相反，应继续不鼓励在近期性交的情况下使用胎儿纤维连接蛋白。
