King's College London

Research portal

The use of fetal fibronectin and cervical length measurements in the prediction of spontaneous preterm birth in women with an Arabin pessary in situ

Research output: Contribution to journalArticlepeer-review

Anastasia Martin, Natalie Suff, Paul T Seed, Anna L David, Joanna Girling, Andrew Shennan

Original languageEnglish
Pages (from-to)113-117
Number of pages5
JournalEuropean Journal of Obstetrics Gynecology and Reproductive Biology
Volume276
Early online date16 Jul 2022
DOIs
Accepted/In press27 Jun 2022
E-pub ahead of print16 Jul 2022
PublishedSep 2022

Bibliographical note

Publisher Copyright: © 2022 Elsevier B.V.

King's Authors

Abstract

Objectives: The ability to predict spontaneous PTB (sPTB) has improved greatly, allowing women at risk to be managed with prophylactic interventions such as cervical cerclage and the Arabin pessary. Cervicovaginal fetal fibronectin (qfFN) concentration and ultrasound measurement of cervical length (CL) are the two most established tools to predict sPTB. There is however limited data regarding the predictive value of qfFN and CL tests following insertion of an Arabin pessary. Our aim was therefore to determine the clinical use of qfFN and CL measurements to predict sPTB in women fitted with an Arabin pessary. Study design: This study is a secondary analysis on the SUPPORT trial data. Data were prospectively collected from women attending high-risk preterm surveillance clinics in 3 London centres between July 2015 and April 2020. The matched control group was pregnant women attending the same high-risk preterm surveillance clinics who had not received an Arabin pessary. Receiver operating characteristic (ROC) curves for prediction of birth by 34 and by 37 weeks’ gestation were generated for qfFN and CL measurements combined for both study groups. A formal comparison of area under the curve before 34 weeks’ gestation (AUC < 34 weeks) was made between the two study groups. Results: At our primary endpoint of sPTB < 34 weeks' gestation, qfFN was a good predictor of sPTB in cases with an Arabin pessary in situ (AUC, 0.79, 95% CI: 0.62–0.90) and no worse than the control group who did not have an Arabin pessary, (AUC 0.74, 95% CI: 0.48–0.96). CL had good prediction for sPTB < 34 weeks’ gestation in the control group (AUC 0.76, 95% CI: 0.63–0.88) but was lower and non-significant in the Arabin pessary case group (AUC 0.60, 95% CI: 0.43–0.76). Conclusions: This study showed that cervicovaginal qfFN concentration is equally reliable in the prediction of sPTB in pregnant women at increased risk of sPTB with and without an Arabin pessary in situ, and significantly better than CL measurement alone for predicting delivery before 34 weeks. This commonly used test therefore has utility in predicting sPTB in pregnant women fitted with an Arabin pessary.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454