Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review

doi:10.1136/bmj.325.7359.301

BMJ 2002;325:301 ( 10 August )

Papers

Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review

Editorial by Colombo

Honest Honest, research fellow, ^a Lucas M Bachmann, research fellow, ^b Janesh K Gupta, senior lecturer, ^a Jos Kleijnen, professor, ^c Khalid S Khan, consultant. ^a

^a Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham B15 2TG, ^b Horten Centre, University of Zurich, Bolleystrasse 40, CH-8091, Zurich, Switzerland, ^c NHS Centre for Reviews and Dissemination, University of York, YorkYO10 5DD

Correspondence to: H Honest h.honest{at}bham.ac.uk

Objective: To determine the accuracy with which a cervicovaginalfetal fibronectin test predicts spontaneous preterm birth in womenwith or without symptoms of pretermlabour.
Design: Systematic quantitative review of studiesof testaccuracy.
Data sources: Medline, Embase, PASCAL, Biosis, CochraneLibrary, Medion, National Research Register, SCISEARCH, conferencepapers, manual searching of bibliographies of known primary andreview articles, and contact with experts andmanufacturer.
Study selection: Two reviewers independently selected and extracteddata on study characteristics, quality, andaccuracy.
Data extraction: Accuracy data were used to form 2×2 contingencytables with spontaneous preterm birth before 34 and 37 weeks'gestation and birth within 7-10 days of testing (for symptomaticpregnant women) as reference standards. Data were pooled to producesummary receiver operating characteristic curves and summary likelihoodratios for positive and negative testresults.
Data synthesis: 64 primary articles were identified, consistingof 28 studies in asymptomatic women and 40 in symptomatic women,with a total of 26 876 women. Among asymptomatic women the bestsummary likelihood ratio for positive results was 4.01 (95% confidenceinterval 2.93 to 5.49) for predicting birth before 34 weeks' gestation,with corresponding summary likelihood ratio for negative resultsof 0.78 (0.72 to 0.84). Among symptomatic women the best summarylikelihood ratio for positive results was 5.42 (4.36 to 6.74)for predicting birth within 7-10 days of testing, with correspondingratio for negative results of 0.25 (0.20 to 0.31).
Conclusion: Cervicovaginal fetal fibronectin test is mostaccurate in predicting spontaneous preterm birth within 7-10 daysof testing among women with symptoms of threatened preterm birthbefore advanced cervicaldilatation.

What is already known on this topic
Spontaneous preterm birth is a major cause of neonatal morbidity and mortality

If spontaneous preterm birth can be predicted, effective therapeutic strategies can be used to improve neonatal outcomes

Though the cervicovaginal fetal fibronectin test has been proposed as a predictive test, estimates of its accuracy are variable

What this study adds
The cervicovaginal fetal fibronectin test is most accurate in predicting spontaneous preterm birth within 7-10 days of testing among women with symptoms of threatened preterm birth before advanced cervical dilatation

After a positive test result 17 symptomatic women at 31 weeks' gestation would need to be treated with antenatal steroids to prevent one case of respiratory distress syndrome

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Rapid Responses:

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RE: Systematic review of the accuracy of fetal fibronectin testing: Richard F. MacLehose, et al.
bmj.com, 5 Sep 2002 [Full text]
Response to BMJ on-line letter: Honest Honest, et al.
bmj.com, 20 Nov 2002 [Full text]