Cervico-vaginal foetal fibronectin: A predictor of cervical response at pre-induction cervical ripening

Context: Not all pregnant women with an “unripe” cervix can be successfully ripened by the cervical ripening agents; therefore tests with predictive information are justified. Objectives: To examine the effect of the presence of foetal fibronectin (FFN) in the cervico-vaginal secretions on pre-induction cervical ripening with either intravaginal Misoprostol or transcervical Foley catheter. Methodology: Twenty (20) patients managed at a tertiary health institution in South-western Nigeria between March and May 2003 were randomised for cervical ripening by either intravaginal Misoprostol or Transcervical Foley catheters. Cervico-vaginal secretions were assessed for presence of FFN with Foetal Fibronectin Enzyme Immunoassay Kit (Adeza Corp.) prior to commencement of cervical ripening. Main outcome measures: FFN status, Pre-ripening and Pre-induction modified Bishop scores and duration of cervical ripening. Results: Ten of the fifteen patients with positive membrane immunoassay for FFN achieved ripened cervix (modified Bishop score ≥ 6) within 6 - 12 hours of exposure to the agents of cervical ripening. In the FFN negative group, only 2 of the five patients achieved ripe cervix within the >12 - 18 hours period, the rest being in the >18 - 24 hours period. Conclusion: Foetal fibronectin test may offer useful predictive information prior to institution of processes of cervical ripening in patients with unfavourable cervices.