الفهرس 
COVEROnly 14 pages are availabe for public view
 |  | from | 173 |  |  |
| | | from | 173 | | |
Abstract
Preterm labor is the leading cause of prenatal morbidity and mortality in the United States. It is characterized by cervical effacement and/or dilatation and increased uterine irritability, before 37 weeks of gestation. Women with a history of preterm labor are at great risk. Strategies for reducing the incidence of preterm labor and delivery have focused on educating both physicians and patients about the risk of preterm labor and methods of detecting preterm cervical dilatation. Current methods of identifying patients at risk of preterm delivery depend on obstetric history, demographic factors, and evaluation of uterine contraction. These methods are neither sensitive nor specific.
As a consequence some patients may be misdiagnosed as preterm labor and receive treatment that may be dangerous for the mother and fetus. On the other hand, late diagnosis and delay in tocolytic therapy adversely influence the likelihood of successful treatment. As the aim is early detection of cases at risk of developing preterm labor, there is a need for more accurate and rapid methods to identify these patients. Fetal fibronectin, a large molecular weight glycoprotein produced in the chorion is expressed in vaginal secretions in women with disruption of the choriodecidual junction by labor or by inflammation. The presence of fetal fibronectin in cervical secretions before 35 weeks is moderately good predictor of preterm delivery. The absence of fetal fibronectin is a strong predictor that preterm delivery is unlikely.
The object of this research is to study the value of fetal fibronectin in pregnant patients presented with established preterm labor with intact membranes compared with Cervico vaginal Swabs versus blind vaginal sample of normal pregnant women.
This was a cross sectional study on (50) patients attending outpatient clinics and inpatient departments of obstetrics and gynecology at Ain Shams University Hospitals with symptoms of preterm labor. regular uterine contractions occurring every 8 minutes or less associated with cervical changes in the form of dilatation of less than 4 cm and/or effacement of 50% or less detected by manual examination in the gestational age between 24 to 34 weeks (gestational age was determined by dating from both first day of last menstrual period, fundal level and ultrasound) from October 2007to June 2011.
All women were subjected to complete history taking, general, abdominal, pelvic examination, sterile speculum examination and special investigation.
The labia were digitally separated a Dacron swab was blindly inserted into the vagina and directed toward the posterior fornix where it was left in place for at least 30 seconds without the aid of a speculum.
With patient in lithotomy position Good Light illumination, sterile Cusco’s speculum was inserted. State of the cervix was observed as regards dilatation and effacement. Samples for detection of fetal fibronectin were taken from the cervix, posterior vaginal fornix by placing a dry Dacron swab against the area for 10 seconds. The specimens were put in sterile plastic containers (Eppendorfs) which were stored at -20°C until testing. The speculum examination and specimen collection were performed before digital examination and before the use of lubricant ts to avoid false positive and false negative results.
Then patient with preterm labor were treated by beta mimetics. Corticosteroids for patients presented before 34weeks.
The results were the presence of fetal fibronectin in the cervicovaginal secretions predicted preterm birth in the studied period of pregnancy as there was significant correlation between duration of pregnancy and fibronectin levels. There was significant correlation between fetal fibronectin and body weight of newborn that when fibronectin was positive the body weight of newborn decreased and sampling delivery interval decreased. The strength of this study is that it evaluates the use of this blind sampling technique in a large, heterogeneous, high risk population. Furthermore, this study evaluates the use of this technique in everyday clinical practice.