In a systemic review and meta-analysis, the authors assessed 6 high quality randomized clinical trials to determine whether the use of fetal fibronectin (FFN) in the clinical setting actually reduces preterm labor. Berghella and Saccone (AJOG, 2016) compared 546 singleton gestations that were randomized to management based on FFN results (intervention group) or not (comparison group). When comparing the intervention to the control group, the researchers found:
No differences in
Statistical difference was identified in
FFN is an extracellular matrix glycoprotein produced during pregnancy by amniocytes and cytotrophoblasts. Studies have shown that increased levels of FFN in vaginal and cervical secretions are associated with spontaneous preterm birth (SPTB). Obtaining FFN is easy and safe, using a swab, and FFN has been used to help providers determine whether to keep patients with symptoms of SPTB under surveillance. While clinical validity has been determined – increased FFN levels are associated with SPTB – this meta-analysis sought to determine clinical utility and whether outcomes are altered in a positive way.
AJOG: Fetal fibronectin testing for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a systematic review and meta-analysis of randomized controlled trials.
AJOG Editorial: Fetal fibronectin testing in threatened preterm labor: time to stop
ACOG has joined ASCCP and the SGO in endorsing the USPSTF cervical cancer screening recommendations. The ACOG practice document states that
Consistent with prior guidance, screening should begin at age 21 years, and screening recommendations remain unchanged for average-risk individuals aged 21–29 years and those who are older than 65 years
Management of abnormal cervical cancer screening results should follow current ASCCP guidelines
The USPSTF recommends the following (Grade A – “Offer or Provide this Service”)
The USPSTF recommends against the following (Grade D – Discourage the use of this service)
Cervical cancer rates in the United States are low due largely to access to effective screening. Cervical cancer is believed with a high degree of certainty, to be the delayed consequence of infection with high risk or oncogenic human papillomavirus (HPV). The majority of HPV infections are transient and do not progress to cervical cancer. However, the consequences of missing precancerous or early cancerous lesions are potentially lethal and should be avoidable with appropriate screening.
Limited access to primary hrHPV testing is of particular concern in rural and under-resourced communities and among communities of color, which have disproportionately high rates of cervical cancer incidence, morbidity, and mortality
Although HPV self-sampling has the potential to greatly improve access to cervical cancer screening, and there is an increasing body of evidence to support its efficacy and utility, it is still investigational in the United States
ACOG: Updated Cervical Cancer Screening Guidelines
ASCCP Management Guidelines and Algorithms
USPSTF (2018): Cervical Cancer Screening
Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society
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