Test that predicts when you'll go into labor- Anyone heard of this?? - Mothering Forums

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Old 12-13-2006, 07:23 PM - Thread Starter
 
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My friend said her OB is doing a sono this week and doing a test that will show if she is going to go into labor within the next two weeks. She is 36 weeks. I asked about it and of course she didn't really know much
Something like a hormone in your cervix lets them know.
I asked if there was a groundhog involved, heheheheh
Anyone heard of this?

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Old 12-13-2006, 07:24 PM
 
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I think she must be talking about a fibrofetinectin (sp) test. It's normally used in preterm labor. Not sure why an almost term mama would have it done. ???
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Old 12-13-2006, 07:30 PM
 
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http://www.marchofdimes.com/professionals/681_1149.asp

It's called fetal fibronectin. It is accurate in predicting if you WON'T deliver in the next two weeks, not if you will. Basically a negative result is 98% accurate, and the positive result is unknown.

I've read that those tests aren't accurate after 34 weeks. And I'm not sure why she'd be having it done anyway. They are meant for diagnosis of women who are at risk for preterm delivery.

I had them at 26 weeks and 33 weeks to rule out preterm delivery. I had been having preterm contractions.
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Old 12-13-2006, 07:44 PM - Thread Starter
 
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Thanks for the info ladies! She isn't at risk for preterm so I'm not sure why she's having it done. Anyone had it done for other reasons? You know OBs. I think they poke and prod us sometimes for their own amusement! Often it is necessary, but sometimes I think they get bored or something.

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Old 12-13-2006, 09:40 PM
 
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there's new data showing that FFN are accurate to term, but (big but coming here) the results can be wrong if there's a) too much mucus (and who isn't mucusy at term), b) sex within the last 24 hours, c) recent cervical exam, or a host of other reasons. So, yes, some providers are using the FFN at term, but there are a lot of problems with doing so (besides the fact that it's bloody expensive and involves a speculum -- never fun).

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Old 12-14-2006, 01:51 AM
 
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Originally Posted by moodyred01 View Post
My friend said her OB is doing a sono this week and doing a test that will show if she is going to go into labor within the next two weeks. She is 36 weeks. I asked about it and of course she didn't really know much
Something like a hormone in your cervix lets them know.
I asked if there was a groundhog involved, heheheheh
Anyone heard of this?
Is it silly to ask why the heck knowing whether or not she'll go into labor in the next 2 weeks is even valuable information to have? I mean, really, what changes either way the test results come, should it actually give some accurate answer to something?
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Old 12-14-2006, 11:12 AM
 
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The real value of the FFN test is in evaluating possible preterm labor. It has a 99% NEGATIVE predictive value, meaning that if the test is negative you almost certainly will not deliver within 14 days. That is valuable information to have if you are 29 weeks along and having frequent contractions and trying to decide whether to risk stopping labor with dangerous drugs or putting a mama on restrictive bedrest. The test is relatively non-invasive, and safe for both mama and baby, and has saved many mamas, myself included, from unnecessary interventions and restrictions, and given a lot of peace of mind.

The test isn't even very accurate as a positive indicator. You get a positive result, and it doesn't mean you will go into labor. You might, you might not. In preterm labor, it signals a mama who needs to take contractions and labor symptoms more seriously, but it doesn't mean she will definitely deliver prematurely.

To give it to a mama at or close to term is just silly. A way to make more money, perhaps? (The test is very expensive.) My insurance will only pay for it before 34 weeks....

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Old 12-17-2006, 01:33 AM
 
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Yes, the FFN is typically used to reassure women who have signs of PTL that they won't deliver preterm. But now some doctors are doing it at term and if/when it is positive, it tells them that an induction is "safer", ie, less likely to lead to a cesarean. I can see some doctors pushing for an induction for no reason at all, or for "pseudomedical" reasons like "your baby is getting big" and "you're getting past your due date" or "you're exhausted, let's get this over with" just because the test is positive. I would refuse it if I were her. There is no reason to know the result other than for the doc to feel better about offering medical induction!!!!

I blogged on this a while ago. See: "A 'Ripe' New Market"

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Old 12-17-2006, 01:42 AM
 
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I have to say I wonder if she's participating in a study. She might not remember saying yes to it.

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Old 12-17-2006, 01:46 AM
 
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My Dr. gave me the test every 2 weeks from 24 weeks to delivery because I have had a classical incision c-section and he wanted to make sure I did not go into labor. Maybe your friend has an issue like that.
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Old 12-17-2006, 12:12 PM
 
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My Dr. gave me the test every 2 weeks from 24 weeks to delivery because I have had a classical incision c-section and he wanted to make sure I did not go into labor. Maybe your friend has an issue like that.
Gossamer
Whether done preterm or at term, this test is good at predicting who won't go into labor but is notoriously terrible at predicting who WILL go into labor. I am not aware of any evidence to support the use of this test to make sure someone with a vertical scar doesn't labor. And what would you do with a positive test? Do a repeat CS to deliver a preterm baby that may or may not be at risk? I don't mean to be catty at all - I really just don't think that this test is useful even in that very special case. And I think - again - that, with the exception of reassuring women with signs of PTL, this test serves no use for women but helps doctors rationalize more and earlier intervention.

Any time a doctor (or midwife for that matter) suggests a test like this, women should automatically demand answers to questions like, "why are we doing this test?" "What does a positive result mean for me?" "What does a negative result mean me?" "Will a certain result cause us to need more tests or procedures?" "What happens if I refuse or delay this test?" Too often, we say "sure!" to a test only to find we have a whole list of unknowns when the results come in - and sometimes wish we never had the test in the first place.
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Old 12-17-2006, 01:29 PM
 
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Whether done preterm or at term, this test is good at predicting who won't go into labor but is notoriously terrible at predicting who WILL go into labor. I am not aware of any evidence to support the use of this test to make sure someone with a vertical scar doesn't labor. And what would you do with a positive test? Do a repeat CS to deliver a preterm baby that may or may not be at risk? I don't mean to be catty at all - I really just don't think that this test is useful even in that very special case. And I think - again - that, with the exception of reassuring women with signs of PTL, this test serves no use for women but helps doctors rationalize more and earlier intervention.

Any time a doctor (or midwife for that matter) suggests a test like this, women should automatically demand answers to questions like, "why are we doing this test?" "What does a positive result mean for me?" "What does a negative result mean me?" "Will a certain result cause us to need more tests or procedures?" "What happens if I refuse or delay this test?" Too often, we say "sure!" to a test only to find we have a whole list of unknowns when the results come in - and sometimes wish we never had the test in the first place.
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Old 12-17-2006, 01:35 PM
 
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Is there a crystal ball included?

Really, unless the mother has a medical condition that requires everyone to KNOW when she goes into labor, is this test really necessary? It seems to me there is abit of "obstetrician stress" that goes with every case of maternal or fetal stress.

Did your insurance cover the cost of the test? Sometimes that is a litmus test as to the real necessity of the test. Otherwise, you are subjecting yourself and your baby to unnecessary ultrasound scans and worry.

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Any time a doctor (or midwife for that matter) suggests a test like this, women should automatically demand answers to questions like, "why are we doing this test?" "What does a positive result mean for me?" "What does a negative result mean me?" "Will a certain result cause us to need more tests or procedures?" "What happens if I refuse or delay this test?" Too often, we say "sure!" to a test only to find we have a whole list of unknowns when the results come in - and sometimes wish we never had the test in the first place.
Absolutely, positively TRUE!
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Old 12-17-2006, 02:32 PM
 
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Really, unless the mother has a medical condition that requires everyone to KNOW when she goes into labor, is this test really necessary?
Again, neither this test nor any test can help us KNOW when labor will begin. Only baby knows that...


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Otherwise, you are subjecting yourself and your baby to unnecessary ultrasound scans and worry.
The fetal fibronectin test is actually a vaginal swab, not an ultrasound. But it's still invasive - if not to the baby then certainly to the woman! And it's expensive - over 200 dollars/test. I sure do hope that insurance companies catch on that this test is expensive and just leading to more (expensive) unnecessary inductions. Or worse, if the test comes back NEGATIVE at term, I can picture a doctor saying "your induction is likely to end in a cesarean so why don't we just cut to the chase..."

Can you tell that I despise this test??!
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Old 12-17-2006, 02:32 PM
 
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The other thing about the FFN test that is just a little crazy is that it doesn't accurately predict PROM. So because I had PPROM'ed with my first, and then was having tons of contractions from 25 weeks on and was taking meds for it, they did lots of FFN tests when I went to the hospital. I had one a few days before my daughter was born that was negative, which helped them decide not to use magnesium sulfate on me (for which I'm very greatful). But then my water broke, and my daughter was born 5 hours later. As a pp mentioned, they aren't supposed to be very accurate after intercourse or a previous vaginal exam (I never heard about the mucous before).

I really don't get the use of this at 36 weeks? My OB told me that the test was ridiculously expensive, and since it was such a rapid test it needed to be done where there was a lab available that could process it quickly. He doesn't even do them in his office, only in the hospital because of all the insurance issues. I'd really question the reasoning behind doing the test for your friend. Is it possible there is something going on she might not want to tell you, maybe like an active herpes outbreak or something?
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Old 12-17-2006, 03:23 PM
 
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Whether done preterm or at term, this test is good at predicting who won't go into labor but is notoriously terrible at predicting who WILL go into labor. I am not aware of any evidence to support the use of this test to make sure someone with a vertical scar doesn't labor. And what would you do with a positive test? Do a repeat CS to deliver a preterm baby that may or may not be at risk? I don't mean to be catty at all - I really just don't think that this test is useful even in that very special case. And I think - again - that, with the exception of reassuring women with signs of PTL, this test serves no use for women but helps doctors rationalize more and earlier intervention.

Any time a doctor (or midwife for that matter) suggests a test like this, women should automatically demand answers to questions like, "why are we doing this test?" "What does a positive result mean for me?" "What does a negative result mean me?" "Will a certain result cause us to need more tests or procedures?" "What happens if I refuse or delay this test?" Too often, we say "sure!" to a test only to find we have a whole list of unknowns when the results come in - and sometimes wish we never had the test in the first place.
SInce I lost my first baby at 24 1/2 weeks,(due to HELLP and pre-eclampsia) having the test done and knowing that I showed no signs of preterm labor was very reassuring to me. I had a wonderful doctor who understood that sometimes tests are done to benefit the mental as well as determine the physical. I did talk to him about what a positive test would mean and what our action would be and he was very upfront in telling me that the negative result was far more reliable than the positive. I did have a repeat c-section at 37 1/2 weeks and had a perfectly healthy happy baby boy. I think we need to realize that yes some doctors do unnecessary tests but every situation is unique and every dr. patient relationship is unique to the dr. and the patient. It is very easy to spout the literature or the statistics, but nobody knows what they would do in somebody else's situation. We know what we would like to do, but unless you have been in someone else's shoes, you don't. I thought I would birth completely naturally with a midwife and absolutely no intervention. I kept telling myself that birth is what my body was designed to do and I did not need to fear it at all. Circumstances changed and both of my births were very medical and full of interventions. But I have a gorgeous baby boy who is the light of my life and a precious baby girl whose spirit flew to heaven. I made my choices based on my experience and just because it is not what most of the mother's here would want, does not mean that I didn't research and question my doctor every step of the way.
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Old 12-17-2006, 08:17 PM
 
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Did your insurance cover the cost of the test? Sometimes that is a litmus test as to the real necessity of the test.
My insurance will cover the test between 24 and 34 weeks (22 to 34 in a multiple pregnancy) for women presenting with signs of preterm labor. Their policy is to pay for the test every two weeks during that time.

I really think that we have to distinguish between the original purpose of the test, and the blatant misuse of the test. I think that use of the test at term is absurd, and certainly the test isn't perfect. It won't predict PROM, and it certainly isn't some kind of fortune-telling device. A positive result is unreliable, and even a negative result is only 99% reliable-- that other 1% represents real mamas and babies, not just numbers. But that doesn't make the test all bad.

Some women having regular contractions and cervical change during that time period are truly in preterm labor, and delaying labor to administer steroids is lifesaving for those babies. Other women just contract a lot, or experience early effacement and dilation, and it's perfectly normal for them, and they go on to carry to term with no treatment at all. The FFN test was intended to sort that out, so as to avoid unnecessary interventions in normal pregnancies.

I would challenge anyone who would tell me that a woman having regular contractions and cervical change at 29 weeks (for example) would be wrong to consent to this test. What would you do in that situation? Tocolytic drugs have terrible side effects and restriction of activity is very hard on a woman's body, but a 29-week preemie and months of life in the NICU are nothing to mess around with either. Preterm contractions have been notoriously over-treated, and the FFN (as well as measurement of cervical length by ultrasound in symptomatic women, another very reliable indicator) offers a way to make evidence-based decisions about how to handle those situations, so that we're no longer just pumping any mama who's contracting full of terbutaline whether or not she really needs it.

It's easy to talk about interventions being unnecessary if you are among the great majority who have uneventful, normal pregnancies. Not all of us do.

But I will still agree that use of the test at term is ridiculous.

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Old 12-18-2006, 01:03 AM
 
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I obviously can't put myself in your shoes, gossamer, and I'm so sorry for your loss. It's reassuring to know that you made a fully informed choice to have the test. I'm afraid that not many women are making that choice, however. I didn't mean to single you out at all.

It's clear to me, though, that doctors are making false promises about what this test can do. Even for preterm labor - which the test was originally approved to predict - the test can't tell you if you're going to go into labor early. And it is definitely important to note that there is essentially no way to prevent or even substantially delay preterm labor once the process has begun. A positive FFN is not going to prevent a 29 weeker from being born, or even give you the time to get steroids on board to speed up lung maturation. The PP mentioned mag sulfate which was recently reaffirmed to have no statistically significant benefit for preventing or delaying preterm birth. Sadly, there is very little we can offer to women who are at risk for preterm birth other than more tests and more anxiety. Ironically, for some women, stress itself contributes to preterm labor. I wonder if we're doing more harm than good with this test.
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Old 12-18-2006, 01:55 AM
 
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It's clear to me, though, that doctors are making false promises about what this test can do. Even for preterm labor - which the test was originally approved to predict - the test can't tell you if you're going to go into labor early. And it is definitely important to note that there is essentially no way to prevent or even substantially delay preterm labor once the process has begun. A positive FFN is not going to prevent a 29 weeker from being born, or even give you the time to get steroids on board to speed up lung maturation. The PP mentioned mag sulfate which was recently reaffirmed to have no statistically significant benefit for preventing or delaying preterm birth. Sadly, there is very little we can offer to women who are at risk for preterm birth other than more tests and more anxiety. Ironically, for some women, stress itself contributes to preterm labor. I wonder if we're doing more harm than good with this test.
I think there are many women here on the NICU forum who would strongly disagree with you on this. Among them are quite a few who had PTL delayed long enough to get steroid shots on board. IT only requires 24-48 hours to be effective, and medications can slow contractions enough for this to be possible.

I think the FFN is very useful in determining how seriously to treat the contractions a woman might be having. Even if you believe labor can't be delayed, birthing plans may need to be changed drastically. It might be possible to get to a hospital with a higher level NICU, for instance. Some labors last longer than 24 hours, and a positive test might help to decide to get the steroid shots immediately, rather than wait and see. It can also be extremely reassuring to get a negative test, since they are so highly accurate. It can, for example, allow a woman to not be restricted from her job, excercise, nursing, and intercourse.

I don't think it is very helpful to a woman experiencing PTL to suggest not to have this test. Even though bedrest and terbutaline or mag sulfate are awful, most women are willing to try anything to increase their chances of keeping a baby in even a few days longer.

It is also pretty offensive to those of us who did everything "right", everything in their power to have a healthy full-term baby to turn it around on us in yet another way, by telling us that it might be because of our stress. Because, you know, we need to feel more guilty about it. : Kind of like telling an infertile person to "relax and it will happen."
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Old 12-18-2006, 02:03 AM
 
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I The PP mentioned mag sulfate which was recently reaffirmed to have no statistically significant benefit for preventing or delaying preterm birth.
Can you provide a link to this information?
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Old 12-18-2006, 11:02 AM
 
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Look, my original intent in joining this thread was to rage against the use of this test at term by doctors who want to rationalize more and earlier intervention. I am not here to disparage any of the choices anyone made in special circumstances when literally death was on the line. I can't ever put myself in that place.

With that said, I'm not stating my opinion. Long-term severe stress is a well documented contributor to the preterm birth rate. I'm NOT saying that people who had preterm births brought it on themselves because they didn't do enough deep breathing exercises. It's obviously multifactorial and the kind of stress that I think contributes to PTL is the kind that people can't just get rid of on their own.

As for the FFN, I personally as a clinician would not wait for FFN results (no matter how fast) if someone really seemed to be in PTL to give steroid shots and/or get the woman to a hospital with a NICU. So the FFN test in an of itself would be a minor player in my decision making (other than in the case of a negative test, which I acknowledge is useful info - for the reasons stated bya PP, to avoid bed rest and other restrictions, reassure the woman, avoid unnecessary interventions, etc.)

And much as we'd all like to believe it does, mag sulfate does not delay preterm birth, has terrible and sometimes lethal side effects, and is not evidence based. Here's the link to the WP article that talks about a Cochrane review that is four years old and yet clinicians still practice the same way.

http://www.washingtonpost.com/wp-dyn...601232_pf.html
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Old 12-18-2006, 01:48 PM
 
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The article that you quoted first of all talks about a study, but doesn't give any data from it. Second of all, it does discuss nifedipine, sometimes called procardia, as an alternative, which doesn't mean that "they can't do anything" to slow or halt PTL. Many women I know have been given this, in fact, it was one of the options they considered with me. It doesn't discuss terbutaline at all, another drug used in the management of PTL.

Strangely enough, although I did develop one of the serious complications discussed by the article, pulmonary edema, from the terbutaline, I would do it again in a heartbeat. You know why? When I wnet in at 32.5 weeks vomiting and contracting every 3 minutes, I feared that she wouuld be born that day. Four days later, she was born at 33 weeks with steroid shots on board, and never needed a ventilator.

FWIW, I agree with your anger over the use of this test at term. Earlier in the thread, I said as much. However when you start arguing against the use of this test by women in circumstances like mine or Gossamer's...well, imo, you should be thankful you never needed to make the choices we did.
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