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The fetal fibronectin test : 25 years after its development, what is the evidence regarding its clinical utility? A systematic review and meta-analysis. / Faron, Gilles; Balepa, Lisa; Parra, José; Fils, Jean-François; Gucciardo, Leonardo.

In: Journal of Maternal-Fetal and Neonatal Medicine, Vol. 32, No. 23, 02.12.2019, p. 3909-3914.

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@article{1da73a67cd404c8dba2e886c0ae00949,
title = "The fetal fibronectin test: 25 years after its development, what is the evidence regarding its clinical utility? A systematic review and meta-analysis",
abstract = "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.",
keywords = "Fetal fibronectin, PAMG-1, PartoSure, preterm birth, preterm delivery",
author = "Gilles Faron and Lisa Balepa and Jos{\'e} Parra and Jean-Fran{\cc}ois Fils and Leonardo Gucciardo",
year = "2019",
month = "12",
day = "2",
doi = "10.1080/14767058.2018.1491031",
language = "English",
volume = "32",
pages = "3909--3914",
journal = "Journal of Maternal-Fetal and Neonatal Medicine",
issn = "1476-7058",
publisher = "Informa Healthcare",
number = "23",

}

RIS

TY - JOUR

T1 - The fetal fibronectin test

T2 - 25 years after its development, what is the evidence regarding its clinical utility? A systematic review and meta-analysis

AU - Faron, Gilles

AU - Balepa, Lisa

AU - Parra, José

AU - Fils, Jean-François

AU - Gucciardo, Leonardo

PY - 2019/12/2

Y1 - 2019/12/2

N2 - 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.

AB - 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.

KW - Fetal fibronectin

KW - PAMG-1

KW - PartoSure

KW - preterm birth

KW - preterm delivery

UR - https://www.tandfonline.com/doi/full/10.1080/14767058.2018.1491031

UR - http://www.mendeley.com/research/fetal-fibronectin-test-25years-after-development-evidence-regarding-clinical-utility-systematic-revi

U2 - 10.1080/14767058.2018.1491031

DO - 10.1080/14767058.2018.1491031

M3 - Article

VL - 32

SP - 3909

EP - 3914

JO - Journal of Maternal-Fetal and Neonatal Medicine

JF - Journal of Maternal-Fetal and Neonatal Medicine

SN - 1476-7058

IS - 23

ER -

ID: 38496888