SMFM meeting paper
Does knowledge of cervical length and fetal fibronectin affect management of women with threatened preterm labor? A randomized trial

Presented at the 27th Annual Clinical Meeting of the Society for Maternal–Fetal Medicine, San Francisco, CA, Feb. 5-10, 2007.
https://doi.org/10.1016/j.ajog.2007.07.017Get rights and content

Objective

The purpose of this study was to estimate the effect of sonographic cervical length (CL) and fetal fibronectin (FFN) on length of evaluation and outcomes in women with preterm labor (PTL).

Study Design

Women with threatened PTL were randomized to either a knowledge group (results of CL and FFN available and used according to study protocol), or a standard group (blinded to CL and FFN). Primary outcome was length of evaluation in triage.

Results

One hundred women were randomized. There was no significant difference between groups in length of evaluation, but in women with CL ≥ 30 mm, the mean time for evaluation was significantly shorter in the knowledge group (1:58 h ± 0:50 vs 2:53 h ± 0:50, P = .004). Incidence of spontaneous preterm birth (SPTB) in the knowledge group was significantly reduced (13.0 vs 36.2%, P = .01).

Conclusion

The knowledge of CL and FFN was associated with reduction in length of evaluation in women with CL ≥ 30 mm and in incidence of SPTB in all women with PTL.

Section snippets

Materials and Methods

We performed a randomized trial of women evaluated for PTL before treatment at the Thomas Jefferson University Hospital, Philadelphia, PA, between November 2004 and April 2006. This study was approved by the Institutional Review Board. Women were eligible for the study if they were between 24 and 33 weeks 6 days; had ≥ 6/contractions/hour, or symptoms suggestive of PTL such as cramping, pressure; were < 3 cm dilated and < 100% effaced and had intact membranes. Exclusion criteria were: known

Results

One hundred women were randomized: 49 to the standard management (blinded) group and 51 to the knowledge group (Figure 2). TVU CL results were obtained in 97 women (2 declined after randomization and 1 CL measurement was not available). FFN results were obtained in 96 women (3 women initially ineligible for FFN did not return for FFN assessment, and 1 was unreadable). FFN results were available within 1 hour at the initial evaluation in 85 women. One woman assigned to the knowledge group who

Comment

We found that knowledge of CL and FFN using a study protocol similar to that proposed by Iams et al5 was not associated with a significant overall effect on length of time for evaluation. But among women with a CL ≥ 30 mm, those in the knowledge group had a significant decrease in the time for evaluation compared to women with a CL ≥ 30 mm in the standard group. According to our protocol, only women with a CL ≥ 30 mm were discharged immediately. Since women with a CL ≥ 30 represent over 50% of

Cited by (0)

Cite this article as: Ness A, Visintine J, Ricci E, et al. Does knowledge of cervical length and fetal fibronectin affect management of women with threatened preterm labor? A randomized trial. Am J Obstet Gynecol 2007;197:426.e1-426.e7.

Reprints not available from the authors.

View full text
Copyright © 2007 Mosby, Inc. All rights reserved.