Blanch G, Oláh K S, Walkinshaw S
Department of Obstetrics and Gynecology, Liverpool University, Liverpool Women's Hospital, United Kingdom.
Am J Obstet Gynecol. 1996 Jan;174(1 Pt 1):262-6. doi: 10.1016/s0002-9378(96)70405-2.
Our purpose was to determine whether the presence of fetal fibronectin in cervicovaginal secretions of patients undergoing induction of labor reflected the cervical state and ultimately the ease of induction of labor.
A prospective observational study of 103 patients undergoing induction of labor at term was conducted at Liverpool Maternity Hospital, a large university teaching hospital. We studied the women after 37 completed weeks of pregnancy. A Dacron (Adeza Biomedical, Sunnyvale, Calif.) polyester swab specimen was first taken from the endocervix for assessment of the presence of the fetal fibronectin. The cervix was then assessed by digital vaginal examination and scored with a modified Bishop's score. The fetal fibronectin swab was processed at the bedside with a membrane immunoassay kit specific for fetal fibronectin. A score was ascribed depending on the strength of the fibronectin reaction determined by the intensity of the color change on the plate, the presence of fetal fibronectin resulting in a score of 1 to 4. The patient was subsequently managed according to the standard induction protocol of the unit. The clinicians involved in the patient's care were blind to the result of the fetal fibronectin swab.
There was a good correlation between the modified Bishop's score and the fetal fibronectin score (r = 0.58, p < 0.001). To predict a latent phase of < 8 hours, a fetal fibronectin score of 3 or 4 has a sensitivity of 73% with a specificity of 83% and a modified Bishop score of > or = 4 has a sensitivity of 75% and a specificity of 73%. For delivery within 12 hours of induction of labor a fetal fibronectin score of > or = 3 has a sensitivity of 61% and specificity of 83% compared with the modified Bishop score of > or = 4, which has a sensitivity of 76% and a specificity of 72.5%.
The fetal fibronectin score is as good as the modified Bishop score as an index of the ease with which induction of labor may be performed. This would imply that it also reflects the proximity of the onset of labor. The presence of fetal fibronectin cervicovaginal secretions is therefore a marker of the changes in the cervix and membranes that precede labor regardless of the gestational age.
我们的目的是确定引产患者宫颈阴道分泌物中胎儿纤维连接蛋白的存在是否反映宫颈状态，并最终反映引产的难易程度。
在一家大型大学教学医院利物浦妇产医院，对103名足月引产患者进行了一项前瞻性观察研究。我们研究的是妊娠满37周后的女性。首先从宫颈内口取一个涤纶（加利福尼亚州森尼韦尔市阿德扎生物医学公司）聚酯拭子标本，以评估胎儿纤维连接蛋白的存在情况。然后通过阴道指诊评估宫颈，并采用改良的 Bishop 评分法进行评分。胎儿纤维连接蛋白拭子在床边使用特定的胎儿纤维连接蛋白膜免疫分析试剂盒进行处理。根据平板上颜色变化的强度所确定的纤维连接蛋白反应强度给出一个分数，存在胎儿纤维连接蛋白得分为1至4分。随后根据该科室的标准引产方案对患者进行处理。参与患者护理的临床医生对胎儿纤维连接蛋白拭子的结果不知情。
改良的 Bishop 评分与胎儿纤维连接蛋白评分之间存在良好的相关性（r = 0.58，p < 0.001）。为预测潜伏期<8小时，胎儿纤维连接蛋白评分为3或4时，敏感性为73%，特异性为83%；改良的 Bishop 评分为≥4时，敏感性为75%，特异性为73%。对于引产12小时内分娩，胎儿纤维连接蛋白评分为≥3时，敏感性为61%，特异性为83%；而改良的 Bishop 评分为≥4时，敏感性为76%，特异性为72.5%。
胎儿纤维连接蛋白评分作为引产难易程度的指标与改良的 Bishop 评分一样好。这意味着它也反映了临产前的时间。因此，宫颈阴道分泌物中胎儿纤维连接蛋白的存在是临产前宫颈和胎膜变化的一个标志，与孕周无关。
