Cervicovaginal fetal fibronectin for the prediction of spontaneous preterm birth in multiple pregnancies: a systematic review and meta-analysis

Abstract

Objective: To investigate the accuracy of cervicovaginal fetal fibronectin in predicting preterm birth in women with multiple pregnancies.

Methods: Systematic review and meta-analysis of predictive test accuracy. Cohort or cross-sectional studies were identified through searches in databases, reference lists, proceedings, and reviews. Study selection, quality assessment, and data extraction were performed. We constructed summary receiver operating characteristic curves and calculated pooled sensitivities and specificities using a bivariate, random-effects meta-regression model. We also calculated summary likelihood ratios and post-test probabilities of preterm birth.

Results: Fifteen studies (11 in asymptomatic women and 4 in women with symptoms of preterm labor) involving 1221 women with multiple pregnancies were included. Among asymptomatic women with multiple or twin pregnancies, the pooled sensitivities, specificities, and positive and negative likelihood ratios for predicting preterm birth before 32, 34, and 37 weeks' gestation ranged from 33% to 45%, 80% to 94%, 2.0 to 5.5, and 0.68 to 0.76, respectively. Among women with twin pregnancies and threatened preterm labor, the test was most accurate in predicting spontaneous preterm birth within 7 days of testing (pooled sensitivity, specificity, and positive and negative likelihood ratios of 85%, 78%, 3.9, and 0.20, respectively).

Conclusions: Cervicovaginal fetal fibronectin provides moderate to minimal prediction of preterm birth in women with multiple pregnancies. The test is most accurate in predicting spontaneous preterm birth within 7 days of testing in women with twin pregnancies and threatened preterm labor.

Figure 1

Study selection process

Figure 2

Methodological quality of studies included in the systematic review. Data presented as percentages across all included studies. Figures in the stacks represent number of studies.

Figure 3

Summary receiver operating characteristic (ROC) curves of cervicovaginal fetal fibronectin for the prediction of spontaneous preterm birth in asymptomatic women with multiple pregnancies. The area of each circle, rectangle and diamond is proportional to study’s sample size.

Figure 4

Summary receiver operating characteristic (ROC) curves of cervicovaginal fetal firbronectin for the prediction of spontaneous preterm birth in asymptomatic women with twin pregnancies. The area of each circle, rectangle, and diamond is proportional to study’s sample size.

Figure 5

Summary receiver operating characteristic (ROC) curves of cervicovaginal fetal firbronectin for the prediction of spontaneous preterm birth in women with twin pregnancies and threatened preterm labor. The area of each circle, rectangle, and diamond is proportional to study’s sample size.