The preterm prediction study: Fetal fibronectin, bacterial vaginosis, and peripartum infection

Objective To determine the relation between vaginal and upper genital tract infection and cervical-vaginal fetal fibronectin levels. Methods We screened 2899 women at ten centers every 2 weeks from 23–24 to 30 weeks' gestation for cervical and vaginal fetal fibronectin. A positive test was defined as a level of at least 50 ng/mL. The relation between a positive test and bacterial vaginosis at 23–24 weeks and clinical or histologic chorioamnionitis at delivery plus neonatal sepsis was determined. Results Fetal fibronectin was present in 4.0% of cervical and/or vaginal samples at 23–24 weeks and was nearly twice as common in women with bacterial vaginosis. Adjusting for the presence of bacterial vaginosis, race, and parity, women positive for fetal fibronectin were much more likely to have clinical chorioamnionitis (mean ± standard deviation gestational age 30.6 ± 4.1 weeks), with an odds ratio of 16.4 and 95% confidence interval of 7.1–37.8, and neonatal sepsis (6.3 and 2.0–20.0, respectively), than those who were fetal fibronectin-negative. A positive cervical fetal fibronectin test was a better predictor of clinical chorioamnionitis and neonatal sepsis than was a vaginal test or a combination of vaginal and cervical tests. Among 40 women who delivered before 32 weeks and had placental histology available for evaluation, ten had a positive cervical and/or vaginal fetal fibronectin test before delivery; all ten had histologic evidence of chorioamnionitis, compared with only 13 of 30 women (43%) who were fetal fibronectin-negative ( P = .02). Conclusion Women with bacterial vaginosis were more likely to have a positive fetal fibronectin test than uninfected women. Women with a positive fetal fibronectin test who delivered before 32 weeks' gestation all had evidence of histologic chorioamnionitis. Women positive for fetal fibronectin also had a 16-fold increase in clinical chorioamnionitis and a sixfold increase in neonatal sepsis. There is strong evidence that upper genital tract infection and cervical and/or vaginal fetal fibronectin are closely linked.