Risk Assessment for Preterm Delivery using the Fetal Fibronectin Test Associated with the Measurement of Uterine Cervix Length in Symptomatic Pregnant Women

Abstract

Objective To analyze the use of the measurement of uterine cervix length (MUCL) and the fetal fibronectin (fFN) rapid test as predictors of preterm delivery (PTD) in symptomatic pregnant women assisted at the Santa Casa de Misericórdia de Sobral Maternity Hospital.

Methods This was a prospective and analytic study involving 53 parturients assisted between September of 2015 and July of 2016; the participants were between 24 and 34 weeks of gestational age (GA) and presented complaints related to preterm labor (PTL) prodromes. Vaginal secretion was collected for fFN testing, and the MUCL was obtained via transvaginal ultrasonography.

Results A total of 58.49% of the subjects showed MUCL < 25 mm, and 41.51% were positive in the fFN rapid test. A total of 48 patients were followed-up until their delivery date, and 54.17% resulted in PTL. The relative risk (RR) for PTD in patients with MUCL < 25 mm was 1.83 (p = 0.09, 0.99–3.36, 95% confidence interval [CI]), with a mean time before delivery of 2.98 weeks. Based on fFN positive results, the RR was 3.50 (p = 0.002, 1.39–8.79, 95%CI) and the mean time until delivery was 1.94 weeks. The RR was 2.70 (p = 0.002, 1.08–6.72, 95%CI) when both tests were used. The RR of PTD within 48 hours, and 7 and 14 days were, respectively, 1.30 (p = 0.11, 95% CI 1.02–1.67), 1.43 (p = 0.12, 95% CI % 0.99–2.06), and 2.03 (p = 0.008, 95% CI 1.26–3.27), when based on the MUCL, and 1.75 (p = 0.0006, 95% CI 1.20–2.53), 2.88 (p = 0.0001, 95% CI, 1.57–5.31), and 3.57 (p = 0.0002, 95% CI 1.63–7.81) when based on positive fFN results. The RR at 48 hours and 7 and 14 days considering both tests was 1.74 (p = 0.0001, 95% CI 1.14–2.64), 2.22 (p = 0.0001, 95% CI 1.22–4.04), and 2.76 (p = 0.0002, 95% CI 1.27–5.96), respectively.

Conclusion In symptomatic pregnant women, we concluded that the MUCL < 25 mm associated with positive fFN rapid test indicate increased the risk for PTD. Further studies with larger sample sizes could contribute in supporting the results presented in the current study.

Resumo

Objetivo Analisar a utilização da medida do comprimento do colo uterino (MCCU), e do teste da fibronectina fetal (FNf) como preditores do trabalho de parto pré-termo (PPT), em gestantes sintomáticas, atendidas na Maternidade da Santa Casa de Misericórdia de Sobral.

Métodos Foi realizado um estudo prospectivo e analítico, envolvendo 53 parturientes atendidas no período de setembro de 2015 a julho de 2016, com idade gestacional (IG) entre 24 e 34 semanas que tiveram queixas relacionadas a pródromos de trabalho de parto prematuro (TPP), sendo realizada coleta de secreção vaginal para FNf e MCCU por via ultrassonográfica transvaginal.

Resultados Um total de 58,49% das pacientes tinham MCCU < 25 mm, e 41,51% tiveram teste rápido de fFN positivo. Foi feito o acompanhamento de 48 pacientes, com 54,17% de PPTs. O risco relativo (RR) para PPT com MCCU < 25 mm foi de 1,83 (p = 0,09, 0,99–3,36, intervalo de confiança [IC] 95%), com média de tempo até o parto de 2,98 semanas. Para fFN, o RR foi de 3.50 (p = 0.002, 1.39–8.79, IC 95%) e a média até o parto foi de 1,94 semanas. Quando os dois testes foram positivos, o RR foi de 2,70 (1,08–6,72). Para a MCCU, o RR para PPT em 48 horas, 7 e 14 dias foram 1,30 (p = 0.11, 95% IC 1.02–1.67), 1,43 (p = 0.12, 95% CI % 0.99–2.06) e 2,03 (p = 0.008, 95% IC 1.26–3.27), respectivamente. Para FNf, em 48 horas, 7 e 14 dias foi de 1,75 (p = 0.0006, 95% IC 1.20–2.53, 2,88 (p = 0.0001, 95% IC, 1.57–5.31) e 3,57 (p = 0.0002, 95% IC 1.63–7.81) respectivamente. Com os dois testes, o RR em 48 horas, 7 e 14 dias foi 1,74 (p = 0.0001, 95%IC 1.14–2.64), 2,22 (p = 0.0001, 95% IC 1.22–4.04) e 2,76 (p = 0.0002, 95% IC 1.27–5.96) respectivamente.

Conclusão Em mulheres grávidas sintomáticas, concluímos que a MCCU < 25 mm e o teste rápido de FNf positivo indicam aumento do risco de PPT. Outros estudos com tamanhos de amostra maiores podem contribuir para apoiar os resultados apresentados no presente estudo.

Keywords

cervical length measurement - fibronectin - pregnancy - preterm labor - risk

Palavras-chave

medida do comprimento cervical - fibronectina - gravidez - trabalho de parto prematuro - risco

Collaborations

Pinheiro Filho T. R. C., Pessoa V. R., Lima T. S., Castro M. M. and Linhares J. J. contributed to the project conception, interpretation of data; critical revision of relevant intellectual content and final approval of the version to be published.

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