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The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth

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The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth. / Hezelgrave, Natasha L; Kuhrt, Katy; Cottam, Kate; Seed, Paul T; Tribe, Rachel M; Shennan, Andrew H.

In: European Journal of Obstetrics Gynecology and Reproductive Biology, Vol. 208, 01.01.2017, p. 103-108.

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Harvard

Hezelgrave, NL, Kuhrt, K, Cottam, K, Seed, PT, Tribe, RM & Shennan, AH 2017, 'The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth', European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 208, pp. 103-108. https://doi.org/10.1016/j.ejogrb.2016.11.027

APA

Hezelgrave, N. L., Kuhrt, K., Cottam, K., Seed, P. T., Tribe, R. M., & Shennan, A. H. (2017). The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth. European Journal of Obstetrics Gynecology and Reproductive Biology, 208, 103-108. https://doi.org/10.1016/j.ejogrb.2016.11.027

Vancouver

Hezelgrave NL, Kuhrt K, Cottam K, Seed PT, Tribe RM, Shennan AH. The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth. European Journal of Obstetrics Gynecology and Reproductive Biology. 2017 Jan 1;208:103-108. https://doi.org/10.1016/j.ejogrb.2016.11.027

Author

Hezelgrave, Natasha L ; Kuhrt, Katy ; Cottam, Kate ; Seed, Paul T ; Tribe, Rachel M ; Shennan, Andrew H. / The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth. In: European Journal of Obstetrics Gynecology and Reproductive Biology. 2017 ; Vol. 208. pp. 103-108.

Bibtex Download

@article{50630a02f0174175a7aefc25079c4d29,
title = "The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth",
abstract = "OBJECTIVE: Spontaneous preterm birth is the leading cause of neonatal morbidity and mortality. Cervicovaginal fetal fibronectin (fFN) has enhanced prediction of preterm birth and, more recently, quantified results have become available so that management can planned more effectively and targeted to individual women. Manufacture guidelines stipulate that fetal fibronectin (fFN) samples should be discarded in the presence of moderate to heavy vaginal bleeding but there hasn't yet been any formal investigation into the effect of blood staining on fetal fibronectin concentration and subsequent preterm birth prediction. The objective for this study was to determine the impact of blood stained swabs on quantitative fetal fibronectin (qfFN) concentration and prediction of spontaneous preterm birth (sPTB) in asymptomatic high-risk women.STUDY DESIGN: Predefined blinded sub-analysis of a larger prospective study of qfFN in asymptomatic women at high-risk of preterm labour. Women with and without blood stained swabs were matched for gestational age at testing and delivery, risk factors and cervical length measurement.RESULTS: Median fFN concentration in blood stained swabs (n=58) was 66ng/ml vs. 7.5ng/ml in the controls (n=58) (p<0.0001). At ≥50ng/ml threshold the false positive ratio (FPR) in blood stained was 25/33 (75.8{\%}) vs. 8/15 (53{\%}) in controls, (risk difference 22.4; -6.8 to 51.6, p=0.18). At ≥50ng/ml threshold the false-negative ratio (FNR) in blood stained was 2/25 (8.0{\%}) vs. 1/43 (2.3{\%}) in controls (risk difference -5.7; -17.2 to 5.9, p=0.55). At each threshold 10, 50 and 200ng/ml blood stained swabs had higher sensitivity but lower specificity for predicting preterm birth. Receiver Operating Characteristic (ROC) curve, the strongest global measure of test performance, for prediction of delivery at <34 weeks gestation was similar in blood stained vs. control groups. (0.78 vs. 0.84) in blood stained vs. control groups respectively.CONCLUSION: Blood stained swabs have elevated qfFN concentrations but may still have predictive value, and clinical utility. Very low fFN values (<10ng/ml) are especially reassuring and indicate lower risk of delivery than non-blood stained swabs. The higher false positive rate must be noted and explained to the patient.",
author = "Hezelgrave, {Natasha L} and Katy Kuhrt and Kate Cottam and Seed, {Paul T} and Tribe, {Rachel M} and Shennan, {Andrew H}",
note = "Copyright {\^A}{\circledC} 2016. Published by Elsevier Ireland Ltd.",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.ejogrb.2016.11.027",
language = "English",
volume = "208",
pages = "103--108",
journal = "European Journal of Obstetrics Gynecology and Reproductive Biology",
issn = "0301-2115",
publisher = "Elsevier Ireland Ltd",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - The effect of blood staining on cervicovaginal quantitative fetal fibronectin concentration and prediction of spontaneous preterm birth

AU - Hezelgrave, Natasha L

AU - Kuhrt, Katy

AU - Cottam, Kate

AU - Seed, Paul T

AU - Tribe, Rachel M

AU - Shennan, Andrew H

N1 - Copyright © 2016. Published by Elsevier Ireland Ltd.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - OBJECTIVE: Spontaneous preterm birth is the leading cause of neonatal morbidity and mortality. Cervicovaginal fetal fibronectin (fFN) has enhanced prediction of preterm birth and, more recently, quantified results have become available so that management can planned more effectively and targeted to individual women. Manufacture guidelines stipulate that fetal fibronectin (fFN) samples should be discarded in the presence of moderate to heavy vaginal bleeding but there hasn't yet been any formal investigation into the effect of blood staining on fetal fibronectin concentration and subsequent preterm birth prediction. The objective for this study was to determine the impact of blood stained swabs on quantitative fetal fibronectin (qfFN) concentration and prediction of spontaneous preterm birth (sPTB) in asymptomatic high-risk women.STUDY DESIGN: Predefined blinded sub-analysis of a larger prospective study of qfFN in asymptomatic women at high-risk of preterm labour. Women with and without blood stained swabs were matched for gestational age at testing and delivery, risk factors and cervical length measurement.RESULTS: Median fFN concentration in blood stained swabs (n=58) was 66ng/ml vs. 7.5ng/ml in the controls (n=58) (p<0.0001). At ≥50ng/ml threshold the false positive ratio (FPR) in blood stained was 25/33 (75.8%) vs. 8/15 (53%) in controls, (risk difference 22.4; -6.8 to 51.6, p=0.18). At ≥50ng/ml threshold the false-negative ratio (FNR) in blood stained was 2/25 (8.0%) vs. 1/43 (2.3%) in controls (risk difference -5.7; -17.2 to 5.9, p=0.55). At each threshold 10, 50 and 200ng/ml blood stained swabs had higher sensitivity but lower specificity for predicting preterm birth. Receiver Operating Characteristic (ROC) curve, the strongest global measure of test performance, for prediction of delivery at <34 weeks gestation was similar in blood stained vs. control groups. (0.78 vs. 0.84) in blood stained vs. control groups respectively.CONCLUSION: Blood stained swabs have elevated qfFN concentrations but may still have predictive value, and clinical utility. Very low fFN values (<10ng/ml) are especially reassuring and indicate lower risk of delivery than non-blood stained swabs. The higher false positive rate must be noted and explained to the patient.

AB - OBJECTIVE: Spontaneous preterm birth is the leading cause of neonatal morbidity and mortality. Cervicovaginal fetal fibronectin (fFN) has enhanced prediction of preterm birth and, more recently, quantified results have become available so that management can planned more effectively and targeted to individual women. Manufacture guidelines stipulate that fetal fibronectin (fFN) samples should be discarded in the presence of moderate to heavy vaginal bleeding but there hasn't yet been any formal investigation into the effect of blood staining on fetal fibronectin concentration and subsequent preterm birth prediction. The objective for this study was to determine the impact of blood stained swabs on quantitative fetal fibronectin (qfFN) concentration and prediction of spontaneous preterm birth (sPTB) in asymptomatic high-risk women.STUDY DESIGN: Predefined blinded sub-analysis of a larger prospective study of qfFN in asymptomatic women at high-risk of preterm labour. Women with and without blood stained swabs were matched for gestational age at testing and delivery, risk factors and cervical length measurement.RESULTS: Median fFN concentration in blood stained swabs (n=58) was 66ng/ml vs. 7.5ng/ml in the controls (n=58) (p<0.0001). At ≥50ng/ml threshold the false positive ratio (FPR) in blood stained was 25/33 (75.8%) vs. 8/15 (53%) in controls, (risk difference 22.4; -6.8 to 51.6, p=0.18). At ≥50ng/ml threshold the false-negative ratio (FNR) in blood stained was 2/25 (8.0%) vs. 1/43 (2.3%) in controls (risk difference -5.7; -17.2 to 5.9, p=0.55). At each threshold 10, 50 and 200ng/ml blood stained swabs had higher sensitivity but lower specificity for predicting preterm birth. Receiver Operating Characteristic (ROC) curve, the strongest global measure of test performance, for prediction of delivery at <34 weeks gestation was similar in blood stained vs. control groups. (0.78 vs. 0.84) in blood stained vs. control groups respectively.CONCLUSION: Blood stained swabs have elevated qfFN concentrations but may still have predictive value, and clinical utility. Very low fFN values (<10ng/ml) are especially reassuring and indicate lower risk of delivery than non-blood stained swabs. The higher false positive rate must be noted and explained to the patient.

U2 - 10.1016/j.ejogrb.2016.11.027

DO - 10.1016/j.ejogrb.2016.11.027

M3 - Article

C2 - 27918947

VL - 208

SP - 103

EP - 108

JO - European Journal of Obstetrics Gynecology and Reproductive Biology

JF - European Journal of Obstetrics Gynecology and Reproductive Biology

SN - 0301-2115

ER -

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