Michel Boulvain

Prediction of preterm delivery by fetal fibronectin: A meta-analysis

Abstract Objective: To assess the cervicovaginal fetal fibronectin test to predict preterm delivery. Data Sources: We searched MEDLINE, Current Contents, Index Medicus , and proceedings of meetings for studies published between 1991 and June 1997. Methods of Study Selection: Inclusion criteria were prospective cohort study; test performed between 20 and 36 weeks’ gestation; fetal fibronectin measured by a previously described assay, with a cutoff level set at 50 ng/mL; test results not disclosed to women or physicians; and fewer than 20% of study participants excluded from the analysis. Tabulation, Integration, and Results: Twenty-nine relevant studies were stratified according to the prevalence of preterm delivery, the number of tests performed, and delivery before 34, 35, or 37 weeks. Sensitivities, specificities, and likelihood ratios were calculated in each study. The summary estimates of the likelihood ratio for tests yielding positive results or tests yielding negative results along with their 95% confidence intervals (CIs) were computed in each stratum according to a random-effects model. All summary likelihood ratios for a test yielding positive results indicated a significant association with preterm delivery. The strongest association was found between a single test with positive results and delivery before 37 weeks in a low-risk population (likelihood ratio 7.5; 95% CI 4.6, 12.3). This association also was found in high-risk women (likelihood ratio 3.5; 95% CI 2.6, 4.6). In high-risk women, a test yielding negative results was associated with a reduction in risk of preterm delivery (likelihood ratio 0.4; 95% CI 0.3, 0.5). Conclusion: Fetal fibronectin in cervicovaginal secretions is associated with preterm delivery in both high-risk and low-risk women.

Short communication: Can we improve the diagnosis of rupture of membranes? The value of insulin-like growth factor binding protein-1

Our objective was to assess the value of insulin‐like growth factor binding protein‐1 (IGFBP‐1) and other tests for the diagnosis of rupture of the membranes (ROM). We included 49 women with suspected ROM. The gold standard for membranes status was defined based on clinical examination, ultrasonography, tests results (except IGFBP‐1) and labour information. Sensitivity, specificity, positive predictive value and negative predictive value of each test were as follows, respectively: IGFBP‐1 (86, 74, 73 and 87%); bromothymol (64, 100, 100 and 77%); fern test (62, 96, 93 and 75%) and ultrasonography (19, 100, 100 and 61%). The detection of IGFBP‐1 in vaginal secretions has high sensitivity for the diagnosis of ROM.

A single cervical fetal fibronectin screening test in; population at low risk for preterm delivery: an improvement on clinical indicators?

Objective To assess the accuracy of a single cervical fetal fibronectin test to predict spontaneous preterm delivery in an unselected antenatal population.

Induction of Labour: Indications and Methods

Abstract This is the first article in a series reporting the proceedings of an international seminar on labour induction which was presented at the Annual Meeting of the SOGC in Quebec in June 1996. The objectives of this seminar are (1) to review the scientific basis for recommendations on labour induction, including post-term pregnancy and prelabour rupture of the amniotic membranes at term, and (2) to review recent techniques for labour induction. This first article will review the most frequent indications for labour induction and will discuss the evidence concerning the management of the post-term pregnancy. It will then review currently available techniques for cervical ripening and discuss the use of prostaglandin gel for labour induction.