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Fibronectin in Singleton Versus Twin Pregnancies - transcript
From 23rd Annual Society for Maternal-Fetal
Medicine (SMFM) Conference held in San Francisco, California - February
2003
Fibronectin in Singleton Versus Twin Pregnancies
Sylvia Pilpel, MD interviewed by Hans van der Slikke, MD, PhD
Hans van der Slikke, MD, PhD:
“It’s February 7, 2003. We are in San Francisco at the meeting of the Maternal Fetal Medicine Society and with me is Sylvia Pilpel. Welcome, Sylvia.”
Sylvia Pilpel, MD: “Thank you.”
Hans van der Slikke, MD, PhD: “Please, for the audience, introduce yourself, where do you work?”
Sylvia Pilpel, MD: “My name is Sylvia Pilpel and I’m a fourth-year resident at Baystate Medical Centre in Springfield, Massachusetts, in the department of OB-GYN.”
Hans van der Slikke, MD, PhD: “You did a study where you measured the fibronectin in pre-term labour, between labour, especially between singletons and twins or multiple pregnancies. Why did you do this study?”
Sylvia Pilpel, MD: “Our goal of the study was to compare the utility of foetal fibronectin testing in twins compared to singletons and we wanted to focus on the twins because there have been very few studies on foetal fibronectin in twins. Most of the large studies in foetal fibronectin have been mainly in singletons, incorporating some sets of twins and triplets, but primarily singletons. So we sought to determine if it was as accurate or useful in twins as it seems to be in singletons.”
Hans van der Slikke, MD, PhD: “How did you design this study?”
Sylvia Pilpel, MD: “Our study was a retrospective study, looking at patients who came in with unscheduled visits with symptoms of pre-term labour and in order to be included in the study, the patients had to have intact membranes and cervixes that were not dilated past three centimetres and they must have had no vaginal bleeding or intercourse or vaginal exams within the prior twenty-four hours because that will alter the foetal fibronectin results. So we collected all the results and compared them between the twins and singletons for delivery within seven days of testing, fourteen days of testing and prior to 34 weeks.”
Hans van der Slikke, MD, PhD: “You had these fibronectin measurements available for everybody?”
Sylvia Pilpel, MD: “Yes.”
Hans van der Slikke, MD, PhD:
“Oh, so that’s the way you can do it retrospectively.”
Sylvia Pilpel, MD: “Yes, and I would mention that it’s a qualitative test, so it measures the presence or absence of foetal fibronectin, not the amount of foetal fibronectin.”
Hans van der Slikke, MD, PhD:
“I see. So it was yes or no.”
Sylvia Pilpel, MD: “Right.”
Hans van der Slikke, MD, PhD:
“And how many patients did you collect?”
Sylvia Pilpel, MD: “We had 47 twins and 770 singletons, which is over a span of approximately two-and-a-half years.”
Hans van der Slikke, MD, PhD:
“And was there a difference?”
Sylvia Pilpel, MD: “There was a difference. We found primarily a stronger negative predictive value in the singletons, about 98%, 99% for delivery within fourteen days and also delivery prior to 34 weeks. For the twins, we found delivery within fourteen days and negative predictive value of about 94%, so it was a little lower than the singletons, but it still seems to be a useful test to predict pre-term delivery.”
Hans van der Slikke, MD, PhD:
“So what was the implication for daily practice?”
Sylvia Pilpel, MD: “The implication is it’s one of the best tests we have right now for predicting pre-term delivery in singletons or twins or triplets at this point and it’s definitely useful to use to see if someone is at risk of pre-term delivery, particularly within fourteen days of testing and prior to 34 weeks.”
Hans van der Slikke, MD, PhD:
“Great. Thank you very much.”
Sylvia Pilpel, MD: “Thank you.”
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