BACKGROUND: The identification of women at risk for preterm birth should allow interventions which could improve neonatal outcome. Fetal fibronectin, a glycoprotein which acts normally as glue between decidua and amniotic membranes could be a good marker of impending labour when its concentration in cervicovaginal secretions between 22 and 36 weeks of gestation is ≥ 50 ng/mL. Many authors worldwide have tested this marker with many different methodologies and clinical settings, but conclusions about its clinical use are mixed. It is time for a comprehensive update through a systematic review and metaanalysis.

METHODS: We searched PubMed, Cochrane Library and Embase, supplemented by manual search of bibliographies of known primary and review articles, international conference papers, and contact with experts from 1-1990 to 2-2018. We have selected all type of studies involving fetal fibronectin test accuracy for preterm delivery. Two authors independently extracted data about study characteristics and quality from identified publications. Contingency tables were constructed. Reference standards were preterm delivery before 37, 36, 35, 34, and 32 weeks, within 28, 21, 14, or 7 days and within 48 hours. Data were pooled to produce summary likelihood ratios for positive and negative tests results.

RESULTS: One hundred and ninety-three primary studies were identified allowing analysis of 53 subgroups. In all settings, none of the summary likelihood ratios were > 10 or < 0.1, thus indicating moderate prediction, particularly in asymptomatic women and in multiple gestations.

CONCLUSIONS: The fetal fibronectin test should not be used as a screening test for asymptomatic women. For high-risk asymptomatic women, and especially for women with multiple pregnancies, performance of the fetal fibronectin test was also too low to be clinically relevant. Consensual use as diagnostic tool for women with suspected preterm labour, the best use policy probably still depends on local contingencies, future cost-effectiveness analysis and comparison with other more recent available biochemical markers.

Original languageEnglish
Pages (from-to)3909-3914
Number of pages31
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume32
Issue number23
DOIs
Publication statusPublished - 2 Dec 2019

    Research areas

  • Fetal fibronectin, PAMG-1, PartoSure, preterm birth, preterm delivery

ID: 38496888