Cervico-Vaginal Foetal Fibronectin for Predicting Preterm Birth in Women with Preterm Contrac-tion: A Cross-sectional Study at a Nigerian Maternity

Abstract

Introduction: Preterm birth contributes substantially to perinatal morbidity, mortality and long-term neuromorbidity among survivors. Its prediction, using foetal fibronectin, may reduce the associated mortality and morbidity. Cervico-vaginal foetal fibronectin (fFN) appears promising, but limited evidence is available on its applicability in low-income countries, with high burden of preterm birth, like Nigeria. This study evaluates the predictability of cervico-vaginal foetal fibronectin (fFN) for preterm birth. Materials and method: A cross-sectional study conducted at the Lagos Island Maternity Hospital; Nigeria evaluated foetal fibronectin in cervico-vaginal secretions of pregnant women. Participants presented with symptoms and/or signs of preterm birth between 28 weeks and 35 weeks’ gestation. Foetal fibronectin was estimated using a Fetal fibronectin testing kit manufactured by Nantong Egens Biotechnology Co., Ltd China ©rapid. Women were offered standard obstetric care as per institutional protocols and followed up till birth. Results: Thirty-three (18.4%) of 179 women had a positive fetal fibronectin result. At 7 days after testing, foetal fibronectin predicted preterm birth with sensitivity, specificity, positive and negative predictive value of 93.3%, 88.4%, 42.4% and 99.3% respectively.  Foetal fibronectin predicted preterm birth before 37 weeks with sensitivity, specificity, positive and negative predictive value of 71.1%, 95.8%, 81.8%, and 92.5% respectively. Sixty-five per cent (116/179) of women had corticosteroids, while 73.2% had tocolysis. Conclusion: The cross-sectional study indicates fetal fetoprotein predicts preterm birth at 7 days with high sensitivity and negative predictive value. The routine use of fibronectin to predict preterm birth in low -income countries may improve the quality of care for women with symptoms of spontaneous preterm labour and perinatal morbidity and mortality in these settings.