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'''Fetal fibronectin''' (fFN) is a [[protein]] produced by [[fetus|fetal]] [[cell (biology)|cells]] and a type of [[fibronectin]]. fFN is found at the interface of the [[chorion]] and the [[decidua]] (between the fetal sack and the [[uterine lining]]).
'''Fetal fibronectin''' (fFN) is a [[fibronectin]] [[protein]] produced by [[fetus|fetal]] [[cell (biology)|cells]]. It is found at the interface of the [[chorion]] and the [[decidua]] (between the fetal sac and the [[uterine lining]]). Fetal fibronectin is found normally in vaginal fluid in early pregnancy prior to 22 weeks due to normal growth and development of tissues at the junction of the uterus and amniotic sac. It may also be found in vaginal fluid after 36 weeks as labor approaches. However, fFN should not be detected between 22 and 36 weeks.<ref name=ffnr>{{cite journal | vauthors = Berghella V, Saccone G | title = Fetal fibronectin testing for reducing the risk of preterm birth | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD006843 | date = July 2019 | pmid = 31356681 | pmc = 6663121 | doi = 10.1002/14651858.CD006843.pub3 }}</ref>


It can be thought of as an adhesive or "biological glue" that binds the fetal sac to the uterine lining.<ref>{{cite web | title = Fetal fibronectin test | work = Mayo Clinic | access-date = 19 March 2016 | url = http://www.mayoclinic.org/tests-procedures/fetal-fibronectin/basics/definition/prc-20014483 }}</ref> It is the product of [[alternative splicing]] of the fibronectin gene and contains a oncofetal domain not present in adult fibronectin.<ref name="pmid32961203">{{cite journal | vauthors = Patten J, Wang K | title = Fibronectin in development and wound healing | journal = Advanced Drug Delivery Reviews | volume = 170 | issue = | pages = 353–368 (357) | date = March 2021 | pmid = 32961203 | doi = 10.1016/j.addr.2020.09.005 | doi-access = free }}</ref>
It can be thought of as an adhesive or "biological glue" that binds the fetal sack to the uterine lining.


==Diagnosic test==
==Screening test==
{{Infobox diagnostic
⚫
Fetal fibronectin "leaks" into the [[vagina]] if a preterm delivery is likely to occur and can be measured in a [[diagnostic test]].<ref>{{cite journal |author=Lockwood CJ, Senyei AE, Dische MR, ''et al'' |title=Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery |journal=N. Engl. J. Med. |volume=325 |issue=10 |pages=669–74 |year=1991 |pmid=1870640 |doi=}}</ref>
| name = Fetal fibronectin
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Fetal fibronectin "leaks" into the [[vagina]] if a preterm delivery is likely to occur and can be measured in a [[screening test]].<ref>{{cite journal | vauthors = Lockwood CJ, Senyei AE, Dische MR, Casal D, Shah KD, Thung SN, Jones L, Deligdisch L, Garite TJ | display-authors = 6 | title = Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery | journal = The New England Journal of Medicine | volume = 325 | issue = 10 | pages = 669–674 | date = September 1991 | pmid = 1870640 | doi = 10.1056/NEJM199109053251001 | doi-access = free }}</ref>


Testing will produce a negative or a positive result. A positive result indicates that fetal fibronectin is present in the cervical secretions. A positive result between 22 and 34 weeks gestation signals an increased risk of preterm birth within the next 7 days. A negative result indicates that there is not fetal fibronectin in the cervical secretions. Fetal fibronectin testing has poor specificity (64%) and positive predictive value (10%).<ref name=":0">{{cite journal | vauthors = Cornelissen LG, van Oostrum NH, van der Woude DA, Rolf C, Porath MM, Oei SG, van Laar JO | title = The diagnostic value of fetal fibronectin testing in clinical practice | journal = The Journal of Obstetrics and Gynaecology Research | volume = 46 | issue = 3 | pages = 405–412 | date = March 2020 | pmid = 31955485 | doi = 10.1111/jog.14201 | s2cid = 210831801 }}</ref> Because of this, the American College of Obstetricians and Gynecologists does not consider positive fFN as diagnostic of prelabor rupture of membranes in the absence of other signs and symptoms and cautions that "[t]hese test kits should be considered ancillary to standard methods of diagnosis."<ref>{{cite journal | vauthors = | title = Prelabor Rupture of Membranes: ACOG Practice Bulletin Summary, Number 217 | journal = Obstetrics and Gynecology | volume = 135 | issue = 3 | pages = 739–743 | date = March 2020 | pmid = 32080044 | doi = 10.1097/AOG.0000000000003701 | s2cid = 211231184 }}</ref>
It is an excellent biological marker of premature (preterm) delivery; a delivery before 37 weeks of [[gestation]].


While the specificity and positive predictive value are poor, fetal fibronectin testing has excellent sensitivity (100%) and negative predictive value (100%). Therefore, a negative fFN test is a very strong indicator that preterm birth is not likely to occur within the next 7 days.<ref name=":0" /> A 2019 Cochrane Review found that while management based on the results of fFN appeared to reduce preterm birth before 37 weeks, the quality of evidence was low.<ref>{{cite journal | vauthors = Berghella V, Saccone G | title = Fetal fibronectin testing for reducing the risk of preterm birth | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD006843 | date = July 2019 | pmid = 31356681 | pmc = 6663121 | doi = 10.1002/14651858.CD006843.pub3 | collaboration = Cochrane Pregnancy and Childbirth Group }}</ref>
When the fFN test is considered positive, it is a less conclusive result. It can indicate that a woman will go into preterm labor soon or she may not go into labor for weeks. When the fFN test is negative, the result is a better predictor. It means that there is little if any danger of [[preterm labour]] for 7-10 days and can be repeated weekly for women who have a high risk of preterm delivery to gauge if they will definitely NOT deliver this week or if it's a possibility. The test is easily performed. A specimen is collected from the patient using a [[vaginal swab]]. The swab is placed in a transport tube and sent to the lab for testing. The lab can easily produce a test result in less than one hour.


The test is easily performed and is usually painless. A specimen is collected from the patient using a vaginal swab. The swab is placed in a transport tube and sent to a laboratory for testing. Most labs can easily produce a result in less than one hour.
A [[systematic review]] of the [[medical literature]] found that fetal fibronectin is a good predictor of spontaneous preterm birth before [[cervical dilation]].<ref>Honest H, Bachmann LM, Gupta JK, Kleijnen J, Khan KS. Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review. BMJ. 2002 Aug 10;325(7359):301. PMID 12169504. [http://bmj.bmjjournals.com/cgi/reprint/325/7359/301.pdf Free Full Text].</ref> The test may be run on patients between 22 and 35 weeks gestation.


At or after 22 weeks of gestation, fFN levels greater than or equal to 50 ng/mL are associated with an increased risk of spontaneous preterm birth.<ref name=ffnr/>
A negative fetal fibronectin test gives a more than 95% likelihood of remaining undelivered for the next 2 weeks. On the other hand, a positive fetal fibronectin test indicates a higher risk of preterm delivery (61% of delivery before 34 weeks)<ref>Farquharson D, Skoll A. Fetal fibronectin. BCRCP Perspectives, Winter 2004. Available at: [http://www.rcp.gov.bc.ca/whatsnew_pdfs/fibronectin.pdf http://www.rcp.gov.bc.ca/whatsnew_pdfs/fibronectin.pdf]. Accessed on: December 25, 2007.</ref>. So, the fetal fibronectin test can't tell you for sure that you are in labor, but it can tell you that you're not.


A false positive fetal fibronectin result can occur if the test is performed after digital examination of the cervix or after having had intercourse. Thus it is important that the swab be taken before a digital cervical exam is performed.
A false positive fetal fibronectin result can occur if the test is performed after digital examination of the cervix or after having had intercourse. It is important that the swab be taken before a digital cervical examination or more than 24 hours following intercourse or previous examination.<ref>{{cite journal | vauthors = Kiefer DG, Vintzileos AM | title = The utility of fetal fibronectin in the prediction and prevention of spontaneous preterm birth | journal = Reviews in Obstetrics & Gynecology | volume = 1 | issue = 3 | pages = 106–112 | date = 2008 | pmid = 19015761 | pmc = 2582650 }}</ref>


==See also==
== See also ==
*[[Fibronectin]]
*[[Fibronectin]]
*[[Fibronectin type II domain]]
*[[Fibronectin type II domain]]
*[[Premature labor]]


==References==
== References ==
{{Reflist}}
{{Reflist}}<!--added above External links/Sources by script-assisted edit-->


==External links==
== External links ==
⚫
* [https://web.archive.org/web/20100327224252/http://www.fibronectintest.co.uk/ Fibronectin Test] - FibronectinTest.co.uk
* [http://www.babycenter.com/0_preterm-labor-test-fetal-fibronectin_1511.bc Fetal fibronectin] - babycenter.com.
⚫
* [http://www.fibronectintest.co.uk/ Fibronectin Test] - FibronectinTest.co.uk


{{Globular proteins}}
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[[Category:Embryology]]
{{Obstetrical procedures}}
[[Category:Obstetrics]]


{{DEFAULTSORT:Fetal Fibronectin}}
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[[Category:Embryology]]
[[Category:Tests during pregnancy]]


[[de:Fibronektin#Fetales Fibronektin]]
{{human-repro-stub}}

Latest revision as of 00:32, 13 August 2023

Fetal fibronectin (fFN) is a fibronectin protein produced by fetal cells. It is found at the interface of the chorion and the decidua (between the fetal sac and the uterine lining). Fetal fibronectin is found normally in vaginal fluid in early pregnancy prior to 22 weeks due to normal growth and development of tissues at the junction of the uterus and amniotic sac. It may also be found in vaginal fluid after 36 weeks as labor approaches. However, fFN should not be detected between 22 and 36 weeks.[1]

It can be thought of as an adhesive or "biological glue" that binds the fetal sac to the uterine lining.[2] It is the product of alternative splicing of the fibronectin gene and contains a oncofetal domain not present in adult fibronectin.[3]

Screening test

[edit]
Fetal fibronectin
Purposetest of pre-term birth

Fetal fibronectin "leaks" into the vagina if a preterm delivery is likely to occur and can be measured in a screening test.[4]

Testing will produce a negative or a positive result. A positive result indicates that fetal fibronectin is present in the cervical secretions. A positive result between 22 and 34 weeks gestation signals an increased risk of preterm birth within the next 7 days. A negative result indicates that there is not fetal fibronectin in the cervical secretions. Fetal fibronectin testing has poor specificity (64%) and positive predictive value (10%).[5] Because of this, the American College of Obstetricians and Gynecologists does not consider positive fFN as diagnostic of prelabor rupture of membranes in the absence of other signs and symptoms and cautions that "[t]hese test kits should be considered ancillary to standard methods of diagnosis."[6]

While the specificity and positive predictive value are poor, fetal fibronectin testing has excellent sensitivity (100%) and negative predictive value (100%). Therefore, a negative fFN test is a very strong indicator that preterm birth is not likely to occur within the next 7 days.[5] A 2019 Cochrane Review found that while management based on the results of fFN appeared to reduce preterm birth before 37 weeks, the quality of evidence was low.[7]

The test is easily performed and is usually painless. A specimen is collected from the patient using a vaginal swab. The swab is placed in a transport tube and sent to a laboratory for testing. Most labs can easily produce a result in less than one hour.

At or after 22 weeks of gestation, fFN levels greater than or equal to 50 ng/mL are associated with an increased risk of spontaneous preterm birth.[1]

A false positive fetal fibronectin result can occur if the test is performed after digital examination of the cervix or after having had intercourse. It is important that the swab be taken before a digital cervical examination or more than 24 hours following intercourse or previous examination.[8]

See also

[edit]

References

[edit]
  1. ^ a b Berghella V, Saccone G (July 2019). "Fetal fibronectin testing for reducing the risk of preterm birth". The Cochrane Database of Systematic Reviews. 7 (7): CD006843. doi:10.1002/14651858.CD006843.pub3. PMC 6663121. PMID 31356681.
  2. ^ "Fetal fibronectin test". Mayo Clinic. Retrieved 19 March 2016.
  3. ^ Patten J, Wang K (March 2021). "Fibronectin in development and wound healing". Advanced Drug Delivery Reviews. 170: 353–368 (357). doi:10.1016/j.addr.2020.09.005. PMID 32961203.
  4. ^ Lockwood CJ, Senyei AE, Dische MR, Casal D, Shah KD, Thung SN, et al. (September 1991). "Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery". The New England Journal of Medicine. 325 (10): 669–674. doi:10.1056/NEJM199109053251001. PMID 1870640.
  5. ^ a b Cornelissen LG, van Oostrum NH, van der Woude DA, Rolf C, Porath MM, Oei SG, van Laar JO (March 2020). "The diagnostic value of fetal fibronectin testing in clinical practice". The Journal of Obstetrics and Gynaecology Research. 46 (3): 405–412. doi:10.1111/jog.14201. PMID 31955485. S2CID 210831801.
  6. ^ "Prelabor Rupture of Membranes: ACOG Practice Bulletin Summary, Number 217". Obstetrics and Gynecology. 135 (3): 739–743. March 2020. doi:10.1097/AOG.0000000000003701. PMID 32080044. S2CID 211231184.
  7. ^ Berghella V, Saccone G, et al. (Cochrane Pregnancy and Childbirth Group) (July 2019). "Fetal fibronectin testing for reducing the risk of preterm birth". The Cochrane Database of Systematic Reviews. 7 (7): CD006843. doi:10.1002/14651858.CD006843.pub3. PMC 6663121. PMID 31356681.
  8. ^ Kiefer DG, Vintzileos AM (2008). "The utility of fetal fibronectin in the prediction and prevention of spontaneous preterm birth". Reviews in Obstetrics & Gynecology. 1 (3): 106–112. PMC 2582650. PMID 19015761.
[edit]
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