Detection of fetal fibronectin in twin pregnancies in relation to gestational age.

CONTEXT: The presence of fetal fibronectin in the cervix or vagina has been investigated as a possible marker for the risk of preterm birth. Fetal fibronectin in cervical fluid can provide direct evidence of pathologic changes at the interface of fetal and maternal tissues. OBJECTIVE: To evaluate the presence of fetal fibronectin as a predictor of premature delivery in twin pregnancies in relation to gestational age. DESIGN: Accuracy study. SETTING: University referral unit. PARTICIPANTS: 52 pregnant women with twin pregnancies and gestational age of between 24 and 34 weeks. MAIN MEASUREMENTS: Sensitivity, specificity, predictive values and relative risk ratios of the correlation between fetal fibronectin and preterm birth before 34 and 37 weeks using an immediate-reading membrane test on cervicovaginal secretions obtained from participants. RESULT: The sensitivity varied between 66.7% and 85.7%, whereas the specificity was from 58.3% to 81.8% according to gestational age at the time of sampling. The relative risk of spontaneous preterm birth after a positive fetal fibronectin test, as compared with a negative fetal fibronectin test, rose from 2.8 at 24-26 weeks to 4.1 at 27-30 weeks. Analyses of the risk of delivery before 34 weeks were not statistically significant. CONCLUSION: Fetal fibronectin in the cervicovaginal secretions of patients with twin pregnancies is a useful tool for the early identification of twin pregnancies likely to deliver before 37 weeks. However, the clinical value of the fibronectin test is limited because of low indices for prediction of delivery before 34 weeks. The best period for performing the fetal fibronectin test in twin pregnancies to predict preterm delivery is between 27 and 30 weeks.

Fetal fibronectin as a predictor of preterm delivery in twin gestations.

OBJECTIVE: To evaluate fetal fibronectin as a predictor of premature delivery in twin pregnancies. METHOD: Cervicovaginal secretions were obtained from 52 pregnant women with twin pregnancies between 24 and 34 weeks of gestation. The secretions were analyzed to detect the presence of fetal fibronectin by immediate-reading membrane test. The correlation between the presence of fetal fibronectin and preterm birth was evaluated. In addition, cervical dilatation and effacement were evaluated with each sampling. RESULT: The sensitivity, specificity, positive predictive value and negative predictive value to predict preterm delivery were 89.3, 50.0, 67.6, and 80.0%, respectively. A positive fetal fibronectin result was associated with a relative risk (RR) for preterm birth of 3.4 (95% CI, 1.2-9.5). A positive fetal fibronectin test associated with cervical dilatation or effacement increased the RR for preterm birth to 4.3 and 7.7, respectively, when compared with those with negative test and without cervical dilatation and effacement. CONCLUSION: Fetal fibronectin in the cervicovaginal secretions of patients with twin pregnancies is a sensitive predictor of preterm delivery. However, because of its low specificity, the fetal fibronectin test should be evaluated along with cervical changes for better identification of twins likely to develop preterm labor.

Risk factors associated to fetal death.

OBJECTIVE: The purpose of this study was to investigate risk factors associated to fetal death in a Brazilian population. DESIGN: A case control study. SETTING: The Hospital Maternidade Leonor Mendes de Barros in São Paulo. PARTICIPANTS: 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks and 244 controls of pregnant women who delivered liveborns. VARIABLES STUDIED: The fetal death (dependent variable), independent variable (the social demographic factors, clinical and obstetrical history, prenatal care indicators and pathological conditions). RESULTS: The risk factors associated to fetal death were abruptio placentae, syphilis, few prenatal care visits, one or more previous stillbirths, hospitalization during pregnancy, diabetes, age above or equal to 25 years, hypertension during pregnancy, anemia and age below 20 years. CONCLUSIONS: Results of the current study might be useful to orientate a primary prevention health program, specially those concerning antenatal care.

Amniocentese periumbilical e suprapubica / Periumbilical and suprapubic amniocentesis

A amniocentese vem sendo empregada cada vez mais frequentemente na gestacao de alto risco mas nao e uma pratica isenta de riscos. Este estudo procura comparar duas tecnicas: a periumbilical e a suprapubica. Um total de 2049 puncoes foram estudadas quanto a facilidade de obtencao de liquido amniotico, as falhas na sua obtencao, a aspiracao de sangue, as irregularidades cardiacas fetais e a rotura das membranas. A incidencia de puncoes negativas foi semelhante em ambas as tecnicas (periumbilical - 10,4%; suprapubica - 8,1%), entretanto a aspiracao de sangue foi muito mais frequente nas puncoes periumbilicais (16,4% versus 7,1%). Complicacoes fetais e placentarias foram observadas apenas no grupo periumbilical, ao passo que a incidencia de rotura de membranas foi muito maior nas amniocenteses suprapubicas (3,8% versus 0,3%).Aconselhamos um estudo sonografico previo, particularmente na puncao periumbilical, e sua indicacao antes da 37a. semana de gravidez; a partir desta epoca dar preferencia a tecnica suprapubica