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PLD.44 Evaluation of fetal fibronectin testing, subsequent management and outcomes in a London teaching hospital
  1. A Lawin-O’Brien,
  2. O Jesner,
  3. C Biswas
  1. The Whittington Hospital, London, UK

Abstract

Preterm birth (PTB) is a major cause of neonatal morbidity and mortality. Fetal fibronectin (FFN) is a valuable predictor of PTB allowing selection of women at risk of PTB, who benefit from corticosteroids, tocolysis and in-utero-transfer. Levels greater than/equal to 50ng/mL are associated with increased risk of PTB. This retrospective audit evaluated FFN testing, subsequent management and outcomes.100 consecutive FFN results were obtained over 5 months, 84 data-sets were collected including 78 patients. 74/84(88%) had a negative result (0–49 ng/ml), 4/84(5%) were mildly raised (50–99 nm/ml) and 1/84(1%) showed moderate levels (100–149 ng/ml). 5/84(6%) showed high levels (>150 ng/ml) and of those, 2/5(40%) delivered prematurely <34/40, 1/5(20%) delivered <37/40 and 2/5(40%) delivered >37/40. Of those with high levels, 4/5(80%) had regular contractions and only 2/5(40%) had abdominal pain. Overall, 68/84(81%) presented with abdominal pain and 61/68(90%) of these had negative results. 23/84(27%) tests were taken from women with regular contractions. Of those with negative tests 1/74(1%) delivered prematurely <34/40 and 3/74(4%) delivered <37/40. However, all premature deliveries occurred >2 weeks after FFN testing. 3/84(4%) tests were managed with tocolysis. Corticosteroids were given after 13/84(16%) tests. Included were 2 in-utero-transfers, one delivered at 36+6/40, the other is unknown. Though numbers remain small this study highlighted the importance of appropriate testing and training of users. Abdominal pain alone appears an insignificant symptom, regular contractions alone or in combination with abdominal pain appear more frequently associated with high FFN-levels. Local protocols should reflect clear indications for testing to avoid costly and inappropriate testing and interventions.

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