Am J Clin Exp Obstet Gynecol 2013;1(1):47-52
Original Article
Prediction of spontaneous preterm birth in patients with congenital
uterine anomalies using combined fetal fibronectin and cervical length
Nathan S Fox, Daniel H Saltzman, Rachel S Gerber, Erica Stern, Chad K Klauser, Andrei Rebarber
Maternal Fetal Medicine Associates, PLLC, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn
School of Medicine at Mount Sinai, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New
York, NY, USA
Received July 25, 2013; Accepted November 10, 2013; Epub December 7, 2013; Published December 15, 2013
Abstract: Objective: To evaluate cervical length (CL) and fetal fibronectin (fFN) as predictors of spontaneous preterm
birth (SPTB) in patients with congenital uterine anomalies. Methods: A retrospective cohort of patients with uterine
anomalies and singleton pregnancies >22 weeks delivered by one maternal fetal medicine practice from 2005-2012
who underwent routine CL and fFN testing from 22-32 weeks was identified. We excluded patients with a cerclage,
and patients who had an indicated preterm birth <37 weeks. A short CL was defined as ≤25 mm. We compared rates
of spontaneous preterm birth <37 weeks based on CL and fFN results. Results: 120 patients with uterine anomalies
were identified (47 septate, 36 bicornuate, 12 unicornuate, 10 arcuate, 9 T-shaped, 6 didelphys). Seventeen (14.2%)
of patients had a short CL; these patients had a higher incidence of spontaneous preterm birth <37 weeks (64.7% vs.
13.6%, p<0.001). Six of 89 patients (6.7%) had a positive fFN; these patients did not have an increased incidence of
spontaneous preterm birth than patients with a negative fFN. The addition of fFN to CL testing did not improve the
positive or negative predictive values, nor the positive or negative likelihood ratios for spontaneous preterm birth <37
weeks. Conclusions: In women with uterine anomalies, a short CL is significantly associated with spontaneous
preterm birth <37 weeks. The addition of fFN testing in these patients does not improve the prediction of preterm birth.
(AJCEOG1307001).
Keywords: Uterine anomaly, preterm birth, fetal fibronectin, cervical length, prediction
Address correspondence to: Dr. Nathan S Fox, Maternal Fetal Medicine Associates, PLLC, 70 East 90th Street, New
York, NY 10128, USA. Tel: 212-722-7409; Fax: 212-722-7185; E-mail: nfox@mfmnyc.com
Original Article
Prediction of spontaneous preterm birth in patients with congenital
uterine anomalies using combined fetal fibronectin and cervical length
Nathan S Fox, Daniel H Saltzman, Rachel S Gerber, Erica Stern, Chad K Klauser, Andrei Rebarber
Maternal Fetal Medicine Associates, PLLC, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn
School of Medicine at Mount Sinai, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New
York, NY, USA
Received July 25, 2013; Accepted November 10, 2013; Epub December 7, 2013; Published December 15, 2013
Abstract: Objective: To evaluate cervical length (CL) and fetal fibronectin (fFN) as predictors of spontaneous preterm
birth (SPTB) in patients with congenital uterine anomalies. Methods: A retrospective cohort of patients with uterine
anomalies and singleton pregnancies >22 weeks delivered by one maternal fetal medicine practice from 2005-2012
who underwent routine CL and fFN testing from 22-32 weeks was identified. We excluded patients with a cerclage,
and patients who had an indicated preterm birth <37 weeks. A short CL was defined as ≤25 mm. We compared rates
of spontaneous preterm birth <37 weeks based on CL and fFN results. Results: 120 patients with uterine anomalies
were identified (47 septate, 36 bicornuate, 12 unicornuate, 10 arcuate, 9 T-shaped, 6 didelphys). Seventeen (14.2%)
of patients had a short CL; these patients had a higher incidence of spontaneous preterm birth <37 weeks (64.7% vs.
13.6%, p<0.001). Six of 89 patients (6.7%) had a positive fFN; these patients did not have an increased incidence of
spontaneous preterm birth than patients with a negative fFN. The addition of fFN to CL testing did not improve the
positive or negative predictive values, nor the positive or negative likelihood ratios for spontaneous preterm birth <37
weeks. Conclusions: In women with uterine anomalies, a short CL is significantly associated with spontaneous
preterm birth <37 weeks. The addition of fFN testing in these patients does not improve the prediction of preterm birth.
(AJCEOG1307001).
Keywords: Uterine anomaly, preterm birth, fetal fibronectin, cervical length, prediction
Address correspondence to: Dr. Nathan S Fox, Maternal Fetal Medicine Associates, PLLC, 70 East 90th Street, New
York, NY 10128, USA. Tel: 212-722-7409; Fax: 212-722-7185; E-mail: nfox@mfmnyc.com
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