CERVICO-VAGINAL FETAL FIBRONECTIN AND ULTRASONOGRAPHIC CERVICAL CHANGES AS PREDICTORS OF PRETERM BIRTH

Abstract

Preterm labor is the leading cause of perinatal morbidity and mortality in I the United states. It is characterized by cervical effacement and/or dilatation and increased uterine irritability, before 37 weeks of gestation. Women with a I history of preterm labor are at greater risk. Strategies for reducing the incidence of preterm labor and delivery have focused on educating both physicians and patients about the risk of preterm labor and methods of detecting preterm cervical dilatation.< 193)

Methods used to predict preterm labor include weekly cervical assessment, transvaginal ultrasongraphy, detection of fetal fibronectin and home uterine activity monitoring. <193 ) Accurate diagnoses of preterm labor remains a problematic issue. Transvaginal cervical sonography in combination with fetal fibronectin are increasingly important in diagnosis and intervention planning. Neither test can, at present, be recommended for screening of the general population since there is no effective intervention for a positive test. < 194 ) I Future directions in research include development of new tocolytic

agents, and clarification of the best use of the adjusted therapies such as betamethasone for lung maturity. <194 )

Fetal fibronectin, a large molecular weight glycobrotein produced in the chorion , is expressed in vaginal secretions in women with disruption of the chorio-decidual junction by labor or by inflammation. <178 )

The presence of FFN in cervical secretions before 35 weeks is moderately good predictor of preterm delivery. The absence of FFN is a strong predictor that preterm delivery is unlikely. <178 ) I I