Mmc Bruijn1, J Y Vis2, F F Wilms3, M A Oudijk4, A Kwee5, M M Porath6, G Oei6, Hcj Scheepers7, Mea Spaanderman7, Kwm Bloemenkamp8, M C Haak8, A C Bolte9, Fpha Vandenbussche9, M D Woiski9, C J Bax10, Jmj Cornette11, J J Duvekot11, Bwa Nij Bijvanck12, J van Eyck12, Mtm Franssen13, K M Sollie13, Jam van der Post4, Pmm Bossuyt14, B C Opmeer15, M Kok4, Bwj Mol16, G-J van Baaren4. 1. Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands. m.m.bruijn@amc.uva.nl. 2. Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands. 3. Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands. 4. Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands. 5. Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands. 6. Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands. 7. Obstetrics and Gynaecology, University Hospital Maastricht, Maastricht, the Netherlands. 8. Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands. 9. Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands. 10. Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands. 11. Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands. 12. Obstetrics and Gynaecology, Isala Clinics, Zwolle, the Netherlands. 13. Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands. 14. Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, the Netherlands. 15. Clinical Research Unit, Academic Medical Centre, Amsterdam, the Netherlands. 16. The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia.
Abstract
OBJECTIVE: To evaluate whether in symptomatic women, the combination of quantitative fetal fibronectin (fFN) testing and cervical length (CL) improves the prediction of preterm delivery (PTD) within 7 days compared with qualitative fFN and CL. DESIGN: Post hoc analysis of frozen fFN samples of a nationwide cohort study. SETTING: Ten perinatal centres in the Netherlands. POPULATION: Symptomatic women between 24 and 34 weeks of gestation. METHODS: The risk of PTD <7 days was estimated in predefined CL and fFN strata. We used logistic regression to develop a model including quantitative fFN and CL, and one including qualitative fFN (threshold 50 ng/ml) and CL. We compared the models' capacity to identify women at low risk (<5%) for delivery within 7 days using a reclassification table. MAIN OUTCOME MEASURES: Spontaneous delivery within 7 days after study entry. RESULTS: We studied 350 women, of whom 69 (20%) delivered within 7 days. The risk of PTD in <7 days ranged from 2% in the lowest fFN group (<10 ng/ml) to 71% in the highest group (>500 ng/ml). Multivariable logistic regression showed an increasing risk of PTD in <7 days with rising fFN concentration [10-49 ng/ml: odds ratio (OR) 1.3, 95% confidence interval (95% CI) 0.23-7.0; 50-199 ng/ml: OR 3.2, 95% CI 0.79-13; 200-499 ng/ml: OR 9.0, 95% CI 2.3-35; >500 ng/ml: OR 39, 95% CI 9.4-164] and shortening of the CL (OR 0.86 per mm, 95% CI 0.82-0.90). Use of quantitative fFN instead of qualitative fFN resulted in reclassification of 18 (5%) women from high to low risk, of whom one (6%) woman delivered within 7 days. CONCLUSION: In symptomatic women, quantitative fFN testing does not improve the prediction of PTD within 7 days compared with qualitative fFN testing in combination with CL measurement in terms of reclassification from high to low (<5%) risk, but it adds value across the risk range. TWEETABLE ABSTRACT: Quantitative fFN testing adds value to qualitative fFN testing with CL measurement in the prediction of PTD.
OBJECTIVE: To evaluate whether in symptomatic women, the combination of quantitative fetal fibronectin (fFN) testing and cervical length (CL) improves the prediction of preterm delivery (PTD) within 7 days compared with qualitative fFN and CL. DESIGN: Post hoc analysis of frozen fFN samples of a nationwide cohort study. SETTING: Ten perinatal centres in the Netherlands. POPULATION: Symptomatic women between 24 and 34 weeks of gestation. METHODS: The risk of PTD <7 days was estimated in predefined CL and fFN strata. We used logistic regression to develop a model including quantitative fFN and CL, and one including qualitative fFN (threshold 50 ng/ml) and CL. We compared the models' capacity to identify women at low risk (<5%) for delivery within 7 days using a reclassification table. MAIN OUTCOME MEASURES: Spontaneous delivery within 7 days after study entry. RESULTS: We studied 350 women, of whom 69 (20%) delivered within 7 days. The risk of PTD in <7 days ranged from 2% in the lowest fFN group (<10 ng/ml) to 71% in the highest group (>500 ng/ml). Multivariable logistic regression showed an increasing risk of PTD in <7 days with rising fFN concentration [10-49 ng/ml: odds ratio (OR) 1.3, 95% confidence interval (95% CI) 0.23-7.0; 50-199 ng/ml: OR 3.2, 95% CI 0.79-13; 200-499 ng/ml: OR 9.0, 95% CI 2.3-35; >500 ng/ml: OR 39, 95% CI 9.4-164] and shortening of the CL (OR 0.86 per mm, 95% CI 0.82-0.90). Use of quantitative fFN instead of qualitative fFN resulted in reclassification of 18 (5%) women from high to low risk, of whom one (6%) woman delivered within 7 days. CONCLUSION: In symptomatic women, quantitative fFN testing does not improve the prediction of PTD within 7 days compared with qualitative fFN testing in combination with CL measurement in terms of reclassification from high to low (<5%) risk, but it adds value across the risk range. TWEETABLE ABSTRACT: Quantitative fFN testing adds value to qualitative fFN testing with CL measurement in the prediction of PTD.
Authors: Catherine E Majors; Chelsey A Smith; Mary E Natoli; Kathryn A Kundrod; Rebecca Richards-Kortum Journal: Lab Chip Date: 2017-10-11 Impact factor: 6.799
Authors: Sarah J Stock; Lisa M Wotherspoon; Kathleen A Boyd; Rachel K Morris; Jon Dorling; Lesley Jackson; Manju Chandiramani; Anna L David; Asma Khalil; Andrew Shennan; Victoria Hodgetts Morton; Tina Lavender; Khalid Khan; Susan Harper-Clarke; Ben W Mol; Richard D Riley; John Norrie; Jane E Norman Journal: BMJ Open Date: 2018-04-07 Impact factor: 2.692