Fetal Fibronectin as a Biomarker of Preterm Labor: A Review of the Literature and Advances in its Clinical Use

Abstract

Spontaneous preterm birth (sPTB) is a challenge in obstetrics today, and is the leading cause of neonatal morbidity and mortality. The ability to predict preterm birth had, until recently, been poor. The biomarker fetal fibronectin (fFN), found at the maternal–fetal interface, when present in high concentrations in cervicovaginal fluid, has been shown to increase the risk of sPTB in symptomatic and asymptomatic women. Recently, further research has been performed into the applicability of such a test to clinical practice, and its effects on management decisions and patient outcomes. Owing to its high negative predictive value, a negative fFN result has been shown to reduce unnecessary interventions, change patient management and reduce healthcare costs, by allowing early reassurance and return to normal care pathways, while care can be concentrated on those at risk. The development of a bedside quantitative fFN test has shown promise to further improve the positive predictive abilities of fFN, as have combined predictive models with cervical length and fFN.

Keywords::

• biomarkers
• cervical cerclage
• fetal fibronectin
• multiple gestations
• prediction
• preterm birth
• quantitative fetal fibronectin

Financial & competing interests disclosure

AH Shennan has, in the field of preterm birth, consultancy arrangements with Alere (who market Actim Partus), GSK and Obseva. A Shennan has received either honoraria, grants and/or equipment for research from Hologic, Qiagen, Medixbiochemica and Ferring. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

AH Shennan has, in the field of preterm birth, consultancy arrangements with Alere (who market Actim Partus), GSK and Obseva. A Shennan has received either honoraria, grants and/or equipment for research from Hologic, Qiagen, Medixbiochemica and Ferring. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.