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Am J Perinatol 2012; 29(04): 267-272
DOI: 10.1055/s-0031-1285827
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Significance of a Positive Fetal Fibronectin in the Setting of a Normal Cervical Length in Twin Pregnancies

Nathan S. Fox
1   Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
,
Andrei Rebarber
1   Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
,
Ashley S. Roman
3   Carnegie Imaging for Women, PLLC, New York, New York
,
Chad K. Klauser
1   Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
,
Daniel H. Saltzman
3   Carnegie Imaging for Women, PLLC, New York, New York
› Author Affiliations
Further Information

Publication History

29 April 2011

06 June 2011

Publication Date:
04 August 2011 (online)

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Abstract

To estimate the risk of preterm birth in asymptomatic women with twin pregnancies with a normal cervical length (CL) and a positive fetal fibronectin (fFN), we reviewed a retrospective cohort of twin pregnancies delivered in our practice from 2005 to 2010. Patients were screened from 22 to 32 weeks with CL and fFN at 2- to 4-week intervals. We examined 244 patients with twin pregnancies and a normal CL (>25 mm) between 22 and 32 weeks and compared outcomes based on the fFN result. Fourteen (5.7%) patients had a positive fFN and 230 (94.3%) patients had a negative fFN. Positive fFN was associated with an increased the risk of spontaneous preterm birth < 37 weeks (85.7% versus 38.3%, p = 0.001), < 35 weeks (50% versus 11.8%, p <  0.001), < 34 weeks (35.7% versus 6.9%, p <  0.001), and < 32 weeks (21.4% versus 2.2%, p <  0.001). On adjusted analysis, a positive fFN was independently associated with preterm birth < 32 weeks (odds ratio 6.8, 95% confidence interval 1.42, 32.2) and gestational age at delivery (p = 0.001). In the setting of a normal CL, a positive fFN is significantly associated with preterm birth in asymptomatic twin pregnancies. Contingency model screening of fFN in asymptomatic twin pregnancies solely based on CL evaluation may fail to identify a cohort of at-risk patients.

Keywords

twins - preterm birth - fetal fibronectin - cervical length
 

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