Examining the relationship between positive mid-gestational fetal fibronectin assays and histological evidence of acute placental inflammation
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Aletha Akers
, Jason A. Jarzembowski , Clark T. Johnson , Richard W. Lieberman and Vanessa K. Dalton
Abstract
Aims: Both acute placental inflammation and positive mid-gestational cervico-vaginal fetal fibronectin assays have been independently correlated with preterm delivery. We conducted this study to examine the relationship between positive mid-gestational fetal fibronectin (fFN) assays and histological evidence of acute placental inflammation at delivery among women presenting with symptomatic preterm labor.
Methods: This retrospective chart review included women who underwent cervico-vaginal fFN testing for preterm contractions between 24–34 weeks gestation and also had placental histological analysis after delivery. Women with a multiple gestation, cerclage, preterm premature rupture of membranes, intercourse or vaginal bleeding within 24 h before the assay were excluded. The primary outcome was histological evidence of acute placental inflammation defined as acute chorioamnionitis, acute deciduitis, funisitis, or microabscess formation.
Results: Of 82 women who met all study inclusion criteria, 45% were fFN positive. Women with positive assays were no more likely to have histological evidence of acute inflammation noted at birth than women with negative assays (45% vs. 26%, P=0.07). The assay had a sensitivity of 58.6%, specificity of 62.3%, positive predictive value of 46.0%, and negative predictive value of 73.3% for predicting acute inflammation at delivery.
Conclusions: No association exists between positive fetal fibronectin assays and acute histologic placental inflammation at birth.
References
[1] Andrews WW, BM Sibai, EA Thom, D Dudley, JM Ernest, D McNellis, et al.: Randomized clinical trial of metronidazole plus erythromycin to prevent spontaneous preterm delivery in fetal fibronectin-positive women. Obstet Gynecol101 (2003) 847Search in Google Scholar
[2] Germain AM, J Carvajal, M Sanchez, GJ Valenzuela, H Tsunekawa, B Chuaqui: Preterm labor: placental pathology and clinical correlation. Obstet Gynecol94 (1999) 284Search in Google Scholar
[3] Goepfert AR, RL Goldenberg, B Mercer, J Iams, P Meis, A Moawad, et al.: The preterm prediction study: quantitative fetal fibronectin values and the prediction of spontaneous preterm birth. Am J Obstet Gynecol183 (2000) 1480Search in Google Scholar
[4] Goldenberg RL, JC Hauth, WW Andrews: Intrauterine infection and preterm delivery. N Engl J Med342 (2000) 1500Search in Google Scholar
[5] Goldenberg RL, M Klebanoff, JC Carey, C Macpherson: Metronidazole treatment of women with a positive fetal fibronectin test result. Am J Obstet Gynecol185 (2001) 485Search in Google Scholar
[6] Goldenberg RL, M Klebanoff, JC Carey, C Macpherson, KJ Leveno, AH Moawad, et al.: Vaginal fetal fibronectin measurements from 8 to 22 weeks' gestation and subsequent spontaneous preterm birth. Am J Obstet Gynecol183 (2000) 469Search in Google Scholar
[7] Goldenberg RL, E Thom, AH Moawad, F Johnson, J Roberts, SN Caritis: The preterm prediction study: fetal fibronectin, bacterial vaginosis, and peripartum infection. NICHD Maternal Fetal Medicine Units Network. Obstet Gynecol87 (1996) 656Search in Google Scholar
[8] Hansen AR, MH Collins, D Genest, D Heller, S Schwarz, P Banagon, et al.: Very low birthweight Infant's placenta and its relation to pregnancy and fetal characteristics. Pediatr Dev Pathol3 (2000) 419Search in Google Scholar
[9] Hansen AR, MH Collins, D Genest, D Heller, S Shen-Schwarz, P Banagon, et al.: Very low birthweight placenta: clustering of morphologic characteristics. Pediatr Dev Pathol3 (2000) 431Search in Google Scholar
[10] Iams JD, D Casal, JA McGregor, TM Goodwin, US Kreaden, R Lowensohn, et al.: Fetal fibronectin improves the accuracy of diagnosis of preterm labor. Am J Obstet Gynecol173 (1995) 141Search in Google Scholar
[11] Lockwood CJ: Recent advances in elucidating the pathogenesis of preterm delivery, the detection of patients at risk, and preventative therapies. Curr Opin Obstet Gynecol6 (1994) 710.1097/00001703-199402000-00003Search in Google Scholar
[12] Lu GC, RL Goldenberg, SP Cliver, US Kreaden, WW Andrews: Vaginal fetal fibronectin levels and spontaneous preterm birth in symptomatic women. Obstet Gynecol97 (2001) 225Search in Google Scholar
[13] Luzzi V, K Hankins, AM Gronowski: Accuracy of the rapid fetal fibronectin TLi system in predicting preterm delivery. Clin Chem49 (2003) 501Search in Google Scholar
[14] Malak TM, F Sizmur, SC Bell, DJ Taylor: Fetal fibronectin in cervicovaginal secretions as a predictor of preterm birth. Br J Obstet Gynaecol103 (1996) 648Search in Google Scholar
[15] Mueller-Heubach E, DN Rubinstein, SS Schwarz: Histologic chorioamnionitis and preterm delivery in different patient populations. Obstet Gynecol 75 (1990) 622Search in Google Scholar
[16] National Center for Health Statistics. Birth Data. http://www.cdc.gov/nchs/births.htm. Accessed April 1, 2005Search in Google Scholar
[17] Ogunyemi D, M Murillo, U Jackson, N Hunter, B Alperson. The relationship between placental histopathology findings and perinatal outcome in preterm infants. J Matern Fetal Neonatal Med13 (2003) 102Search in Google Scholar
[18] Peaceman AM, WW Andrews, JM Thorp, SP Cliver, A Lukes, JD Iams, et al.: Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial. Am J Obstet Gynecol177 (1997) 13Search in Google Scholar
[19] Redline RW: Placental pathology: a neglected link between basic disease mechanisms and untoward pregnancy outcome. Curr Opin Obstet Gynecol7 (1995) 1010.1097/00001703-199507010-00003Search in Google Scholar
[20] Rizzo G, A Capponi, A Vlachopoulou, E Angelini, C Grassi, C Romanini: The diagnostic value of interleukin-8 and fetal fibronectin concentrations in cervical secretions in patients with preterm labor and intact membranes. J Perinat Med25 (1997) 461Search in Google Scholar
[21] Salafia CM, LM Ernst, JC Pezzullo, EJ Wolf, TS Rosenkrantz, AM Vintzileos: The very low birthweight infant: maternal complications leading to preterm birth, placental lesions, and intrauterine growth. Am J Perinatol12 (1995) 106Search in Google Scholar
[22] Salafia CM, JF Mill: The value of placental pathology in studies of spontaneous prematurity. Curr Opin Obstet Gynecol8 (1996) 89Search in Google Scholar
[23] Salafia CM, CA Vogel, KF Bantham, AM Vintzileos, J Pezzullo, L Silberman: Preterm delivery: correlations of fetal growth and placental pathology. Am J Perinatol9 (1992) 190Search in Google Scholar
[24] Salafia CM, CA Vogel, AM Vintzileos, KF Bantham, J Pezzullo, L Silberman: Placental pathologic findings in preterm birth. Am J Obstet Gynecol165 (1991) 934Search in Google Scholar
[25] Shennan A, S Crawshaw, A Briley, J Hawken, P Seed, G Jones, et al.: A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. Bjog113 (2006) 65Search in Google Scholar
[26] Stetzer BP, BM Mercer: Antibiotics and preterm labor. Clin Obstet Gynecol43 (2000) 809Search in Google Scholar
[27] Stevens AO, SP Chauhan, EF Magann, RW Martin, JA Bofill, JL Cushman, et al.: Fetal fibronectin and bacterial vaginosis are associated with preterm birth in women who are symptomatic for preterm labor. Am J Obstet Gynecol190 (2004) 1582Search in Google Scholar
[28] Yoon BH, R Romero, JB Moon, SY Oh, SY Han, JC Kim, et al.: The frequency and clinical significance of intra-amniotic inflammation in patients with a positive cervical fetal fibronectin. Am J Obstet Gynecol185 (2001) 1137Search in Google Scholar
©2007 by Walter de Gruyter Berlin New York
Articles in the same Issue
- Cervical surgery and preterm birth
- How useful is 3D and 4D ultrasound in perinatal medicine?
- The combined effect of maternal smoking and obesity on the risk of preeclampsia
- Slow change in body mass index during early triplet pregnancy is associated with decreased birth weight
- Examining the relationship between positive mid-gestational fetal fibronectin assays and histological evidence of acute placental inflammation
- Paternal smoking is associated with a decreased prevalence of type 1 diabetes mellitus among offspring in two national British birth cohort studies (NCDS and BCS70)
- Three-dimensional ultrasound power Doppler assessment of the cervix: comparison between nulliparas and multiparas
- Gender- and parity-specific reference charts for fetal size in low risk singleton pregnancies at the onset of the third trimester
- Near term twin pregnancy: clinical relevance of weight discordance at birth
- Intracerebellar hemorrhage in premature infants: sonographic detection and outcome
- Determining the least time required for measuring energy expenditure in premature neonates
- Neither maternal nor fetal mutation (E474Q) in the α-subunit of the trifunctional protein is frequent in pregnancies complicated by HELLP syndrome
- Long-term subcutaneous morphine administration after surgery in newborns
- Superior sagittal sinus thrombosis: a rare but serious complication of hypernatremic dehydration in newborns
- Congress Calendar
- Roster of Perinatal Societies
Articles in the same Issue
- Cervical surgery and preterm birth
- How useful is 3D and 4D ultrasound in perinatal medicine?
- The combined effect of maternal smoking and obesity on the risk of preeclampsia
- Slow change in body mass index during early triplet pregnancy is associated with decreased birth weight
- Examining the relationship between positive mid-gestational fetal fibronectin assays and histological evidence of acute placental inflammation
- Paternal smoking is associated with a decreased prevalence of type 1 diabetes mellitus among offspring in two national British birth cohort studies (NCDS and BCS70)
- Three-dimensional ultrasound power Doppler assessment of the cervix: comparison between nulliparas and multiparas
- Gender- and parity-specific reference charts for fetal size in low risk singleton pregnancies at the onset of the third trimester
- Near term twin pregnancy: clinical relevance of weight discordance at birth
- Intracerebellar hemorrhage in premature infants: sonographic detection and outcome
- Determining the least time required for measuring energy expenditure in premature neonates
- Neither maternal nor fetal mutation (E474Q) in the α-subunit of the trifunctional protein is frequent in pregnancies complicated by HELLP syndrome
- Long-term subcutaneous morphine administration after surgery in newborns
- Superior sagittal sinus thrombosis: a rare but serious complication of hypernatremic dehydration in newborns
- Congress Calendar
- Roster of Perinatal Societies