The Role of Fetal Fibronectin Testing in the Management of Threatened Preterm Labor: A Systematic Review

Abstract

Introduction: Threatened preterm labor is a common reason for hospital admission, but most women do not deliver prematurely. Fetal fibronectin (fFN) is a biomarker used to predict preterm birth. This review assesses its clinical utility in managing threatened preterm labor.

Methods: We conducted a systematic review of studies assessing the diagnostic accuracy of cervicovaginal fFN testing in symptomatic women. The primary outcome was the negative predictive value (NPV) of the test for predicting delivery within 7-14 days.

Results: The meta-analysis of numerous prospective cohort studies demonstrated that a negative fFN test has a very high negative predictive value (over 98%) for delivery within the subsequent 14 days. A positive test had a much lower positive predictive value.

Discussion: The primary strength of the fFN test is its ability to rule out imminent preterm birth. A negative result can provide reassurance to clinicians and patients, potentially preventing unnecessary hospital admissions, corticosteroid administration, and maternal transfers.

Conclusion: A negative fetal fibronectin test is a powerful tool for ruling out imminent preterm birth in women with threatened preterm labor.