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ARTICLE |

Obstetrics and Gynecology FREE

Roy M. Pitkin, MD
JAMA. 1996;275(23):1829-1830. doi:10.1001/jama.1996.03530470057034
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Prematurity is the leading cause of infant morbidity and mortality in the United States, so research into the causes and prevention of preterm birth occupies the highest priority in the field of obstetrics. Before a prevention program can be tested, a reliable means of identifying pregnancies at risk must be available. Scoring systems, based mainly on demographic characteristics, were developed a decade or more ago. Initially, they seemed promising, but experience has shown them to be inadequate as clinical predictors.

The most promising candidate as a predictor of preterm labor is fibronectin, a cellular glycoprotein normally present as a specific isoform in various fetal tissues (as well as in certain malignant neoplasms). Fetal fibronectin can be measured with an immunoassay using a monoclonal antibody, and in cervical secretions the critical level seems to be about 50 ng/mL. When levels exceed this cutoff, presumably reflecting disruption or other alteration of the

REFERENCES

Lockwood CJ, Senyei AE, Dische MR, et al.  Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery. N Engl J Med . 1991;;325:669-674.
Nageotte MP, Casal D, Senyei AE.  Fetal fibronectin in patients at increased risk for premature birth. Am J Obstet Gynecol . 1994;;170:20-25.
Hellemans P, Gerris J, Verdonk P.  Fetal fibronectin detection for prediction of preterm birth in low risk women. Br J Obstet Gynaecol . 1995;;102:207-212.
Iams JD, Casal D, McGregor JA, et al.  Fetal fibronectin improves the accuracy of diagnosis of preterm labor. Am J Obstet Gynecol . 1995;;173:141-145.
Khandelwal M, Lynch L, Lockwood CJ, Ainbender E.  Maternal serum levels of alpha-fetoprotein and fetal fibronectin as markers of labor in the third trimester. Am J Perinatol . 1995;;12:161-163.
Palermo GD, Cohen J, Alikani M, Adler A, Rosenwaks Z.  Intracytoplasmic sperm injection: a novel treatment for all forms of male factor infertility. Fertil Steril . 1995;; 63:1231-1240.
Harari O, Bourne H, McDonald M, et al.  Intracytoplasmic sperm injection: a major advance in the management of severe male subfertility. Fertil Steril . 1995;;64:360-368.
Tarin JJ.  Subzonal insemination, partial zona dissection or intracytoplasmic sperm injection? an easy decision? Hum Reprod . 1995;;10:165-170.
Nagy Z, Liu J, Cecile J, Silber S, Devroey P, Van Steirteghem A.  Using ejaculated, fresh, and frozen-thawed epididymal and testicular spermatozoa gives rise to comparable results after intracytoplasmic sperm injection. Fertil Steril . 1995;;63:808-815.
Hatch KD, Schneider A, Abdel-Nour MW.  An evaluation of human papillomavirus testing for intermediate- and high-risk types as triage before colposcopy. Am J Obstet Gynecol . 1995;;172:1150-1157.
Lungu O, Sun XW, Wright TC Jr, Ferenczy A, Richart RM, Silverstein S.  A polymerase chain reaction-enzyme-linked immunosorbent assay method for detecting human papillomavirus in cervical carcinomas and high-grade cervical cancer precursors. Obstet Gynecol . 1995;;85:337-342.
Sun XW, Ellerbrock TV, Lungu O, Chiasson MA, Bush TJ, Wright TC Jr.  Human papillomavirus infection in human immunodeficiency virus-seropositive women. Obstet Gynecol . 1995;;85:680-686.
Palefsky JM.  Human papilloma virus-associated anogenital neoplasia and other solid tumors in human immunodeficiency virus-infected individuals. Curr Opin Oncol . 1991;;3:881-885.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Lockwood CJ, Senyei AE, Dische MR, et al.  Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery. N Engl J Med . 1991;;325:669-674.
Nageotte MP, Casal D, Senyei AE.  Fetal fibronectin in patients at increased risk for premature birth. Am J Obstet Gynecol . 1994;;170:20-25.
Hellemans P, Gerris J, Verdonk P.  Fetal fibronectin detection for prediction of preterm birth in low risk women. Br J Obstet Gynaecol . 1995;;102:207-212.
Iams JD, Casal D, McGregor JA, et al.  Fetal fibronectin improves the accuracy of diagnosis of preterm labor. Am J Obstet Gynecol . 1995;;173:141-145.
Khandelwal M, Lynch L, Lockwood CJ, Ainbender E.  Maternal serum levels of alpha-fetoprotein and fetal fibronectin as markers of labor in the third trimester. Am J Perinatol . 1995;;12:161-163.
Palermo GD, Cohen J, Alikani M, Adler A, Rosenwaks Z.  Intracytoplasmic sperm injection: a novel treatment for all forms of male factor infertility. Fertil Steril . 1995;; 63:1231-1240.
Harari O, Bourne H, McDonald M, et al.  Intracytoplasmic sperm injection: a major advance in the management of severe male subfertility. Fertil Steril . 1995;;64:360-368.
Tarin JJ.  Subzonal insemination, partial zona dissection or intracytoplasmic sperm injection? an easy decision? Hum Reprod . 1995;;10:165-170.
Nagy Z, Liu J, Cecile J, Silber S, Devroey P, Van Steirteghem A.  Using ejaculated, fresh, and frozen-thawed epididymal and testicular spermatozoa gives rise to comparable results after intracytoplasmic sperm injection. Fertil Steril . 1995;;63:808-815.
Hatch KD, Schneider A, Abdel-Nour MW.  An evaluation of human papillomavirus testing for intermediate- and high-risk types as triage before colposcopy. Am J Obstet Gynecol . 1995;;172:1150-1157.
Lungu O, Sun XW, Wright TC Jr, Ferenczy A, Richart RM, Silverstein S.  A polymerase chain reaction-enzyme-linked immunosorbent assay method for detecting human papillomavirus in cervical carcinomas and high-grade cervical cancer precursors. Obstet Gynecol . 1995;;85:337-342.
Sun XW, Ellerbrock TV, Lungu O, Chiasson MA, Bush TJ, Wright TC Jr.  Human papillomavirus infection in human immunodeficiency virus-seropositive women. Obstet Gynecol . 1995;;85:680-686.
Palefsky JM.  Human papilloma virus-associated anogenital neoplasia and other solid tumors in human immunodeficiency virus-infected individuals. Curr Opin Oncol . 1991;;3:881-885.
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