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Can the fetal fibronectin test be used by remote dwelling pregnant women to predict the onset of labour at term and delay transfer for birth in regional settings?

Rumbold, Alice R., Kruske, Sue, Boyle, Jacqueline A., Weckert, Rosemary, Putland, Sally, Giles, Lynne, Barclay, Lesley M. and Kildea, Sue V. (2013). Can the fetal fibronectin test be used by remote dwelling pregnant women to predict the onset of labour at term and delay transfer for birth in regional settings?. Rural and Remote Health,13(2126):2126-1-2126-9.

Document type: Journal Article
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IRMA ID MENbsnellxPUB71
Title Can the fetal fibronectin test be used by remote dwelling pregnant women to predict the onset of labour at term and delay transfer for birth in regional settings?
Author Rumbold, Alice R.
Kruske, Sue
Boyle, Jacqueline A.
Weckert, Rosemary
Putland, Sally
Giles, Lynne
Barclay, Lesley M.
Kildea, Sue V.
Journal Name Rural and Remote Health
Publication Date 2013
Volume Number 13
Issue Number 2126
ISSN 1445-6354   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84877919027
Start Page 2126-1
End Page 2126-9
Total Pages 9
Place of Publication Melbourne, Australia
Publisher Australian Rural Health Education Network
HERDC Category C1 - Journal Article (DIISR)
Abstract Introduction:
The closure of rural maternity units in Australia means an increasing number of women are transferred into major centres to await birth. Accurately excluding the onset of labour could delay relocation. The fetal fibronectin (fFN) test is used to predict preterm birth; however, the accuracy of this test for determining impending term birth is unclear.

Methods:
In all 75 women were recruited to this study from two remote maternity units. Eligibility criteria were: aged ≥18 years, singleton pregnancy, 37+0–40+3 weeks (37 weeks to 40 weeks and 3 days gestation) and no indication for induction of labour or caesarean section in next 7 days. The Quikcheck fFN® test was performed at 37 weeks and then repeated at 7 day intervals. Time-to-birth from test date was modelled using linear regression. Logistic regression models estimated odds of birth within 7 days. Separate models considered first and last test results and those at 38 weeks; adjusted for use of lubricant and gestational age.

Results:
A shorter time-to-birth was found in women with positive compared with negative fFN tests; significant at first fFN test (adjusted mean difference [AMD] 5.4 days, 95% CI 2.0-8.8) and 38 weeks (AMD 5.7 days, 95% CI 2.2-9.2 days). A positive test was also associated with a significant increase in the odds of birthing within 7 days: first fFN test adjusted odds ratio (AOR) 11.0 (95% CI 2.5-48.7), 38 weeks test AOR 14.4 (95% CI 3.4-60.2), last fFN test AOR 8.1 (95% CI 1.6-39.8). However, of women who gave birth within 7 days of testing a significant proportion had a negative fFN result; first fFN test 8/17(47.1%), 38 weeks test 4/14(28.6%) and last fFN test 29/58(50.0%).

Conclusion:
The presence of fFN in cervical secretions was associated with impending term birth but its absence did not reliably exclude the onset of birth. Delaying transfer based on these findings would result in some women birthing in their home communities.
Keywords Australia
fFn protein
Fibronectin
Relocation for birth
Rural/remote pregnancy
Term birth
Description for Link Link to published version
URL http://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=2126


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