Fetal fibronectin in the prediction of preterm birth

Accurate prediction of preterm birth is a big clinical challenge in obstetrics. Most of the women presenting with symptoms of preterm labour will not deliver within one week and the majority will even deliver at term. Correct discrimination between women with a high and a low risk to deliver on short term would, on the one hand, enable targeted interventions and transfer to an appropriate referral centre to improve neonatal outcomes, and, on the other hand, reduce overtreatment and unnecessary health care costs. Fetal fibronectin (fFN) is the most commonly used biomarker in the prediction of preterm birth. It is a glycoprotein that acts like ’glue’ between the maternal-fetal interface and the detection of fFN at a gestational age between 24 and 34 weeks is associated with an increased risk of preterm birth. The most commonly used fFN test is a qualitative test, which gives a positive or negative result based on a 50 ng/mL threshold. More recently, a new bedside test has been developed, measuring the fFN concentration in the cervicovaginal fluid. The aim of the research presented in this thesis was to evaluate the use of both the qualitative and quantitative fFN test in the prediction of spontaneous preterm birth in women with symptoms of preterm labour, mostly in combination with other predictors such as cervical length, in order to obtain the best approach in individualised risk assessment. The more accurately we can predict a woman’s risk, the better we can manage her pregnancy, only intervening when necessary.