Predictive accuracy of serial transvaginal cervical lengths and quantitative vaginal fetal fibronectin levels for spontaneous preterm birth among nulliparous women

M. Sean Esplin, Michal A. Elovitz, Jay D. Iams, Corette B. Parker, Ronald J. Wapner, William A. Grobman, Hyagriv N. Simhan, Deborah A. Wing, David M. Haas, Robert M. Silver, Matthew K. Hoffman, Alan M. Peaceman, Steve N. Caritis, Samuel Parry, Pathik Wadhwa, Tatiana Foroud, Brian M. Mercer, Shannon M. Hunter, George R. Saade, Uma M. Reddy

Research output: Contribution to journalArticlepeer-review

141 Scopus citations


IMPORTANCE Spontaneous preterm birth is a leading cause of infant mortality. Prediction, largely based on prior pregnancy outcomes, is not possible in women pregnant for the first time. OBJECTIVE To assess the accuracy of universal screening to predict spontaneous preterm birth in nulliparous women using serial measurements of vaginal fetal fibronectin levels and cervical length. DESIGN, SETTINGS, AND PARTICIPANTS A prospective observational cohort study of nulliparous women with singleton pregnancies, from 8 clinical sites across the United States between October 2010 and May 2014.Women and clinicians were blinded to results unless cervical shortening less than 15mmwas identified. EXPOSURES Transvaginal cervical length and quantitative vaginal fetal fibronectin levels were reviewed at 2 study visits 4 or more weeks apart. MAIN OUTCOMES AND MEASURES Spontaneous preterm birth at less than 37weekswas the primary outcome. Cervical length and quantitative fetal fibronectin were considered independently and together at each visit. Measurement distributions were compared for spontaneous preterm birth vs all other births. Spontaneous preterm birth before 32 weeks was a secondary outcome. RESULTS The study included 9410 women (median age, 27.0 [interquartile range, 9.0] years; 60.7%non-Hispanic white, 13.8% non-Hispanic black, 16.5%Hispanic, 4.0%Asian, and 5.1% other), of whom 474 (5.0%) had spontaneous preterm births, 335 (3.6%) had medically indicated preterm births, and 8601 (91.4%) had term births. Among women with spontaneous preterm birth, cervical length of 25mmor less occurred in 35 of 439 (8.0%) at 16 to 22 weeks' gestation and in 94 of 403 (23.3%) at 22 to 30 weeks' gestation. Fetal fibronectin levels of 50 ng/mL or greater at 16 to 22 weeks identified 30 of 410 women (7.3%) with spontaneous preterm birth and 31 of 384 (8.1%) at 22 to 30 weeks. The area under the receiver operating characteristic curve for screening between 22 and 30 weeks for fetal fibronectin level alone was 0.59 (95%CI, 0.56-0.62), for transvaginal cervical length alone was 0.67 (95%CI, 0.64-0.70), and for the combination as continuous variables was 0.67 (95%CI, 0.64-0.70). CONCLUSIONS AND RELEVANCE Among nulliparouswomen with singleton pregnancies, quantitative vaginal fetal fibronectin and serial transvaginal ultrasound cervical length had low predictive accuracy for spontaneous preterm birth. These findings do not support routine use of these tests in such women.

Original languageEnglish (US)
Pages (from-to)1047-1056
Number of pages10
JournalJAMA - Journal of the American Medical Association
Issue number10
StatePublished - Mar 14 2017

ASJC Scopus subject areas

  • General Medicine


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