الفهرس 
The Human CervixOnly 14 pages are availabe for public view
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Abstract
M
isoprostol is a synthetic PG El analogue. Because of its cervical ripening and uterotonic property, misoprostol has become one of the most useful drugs in obstetrics and gynecology. Misoprostol has quickly become established as one of the most effective drugs for terminating pregnancies in the first and second trimesters, as well as for inducing labor in the third trimester.
Fetal fibronectin is detected in cervicovaginal secretions in women who have normal pregnancies with intact membranes at term, and it appears to reflect stromal remodeling of the cervix prior to labor.
Before 20th week of gestation, fetal fibronectin is normally found in the cervix and vagina; its presence is thought to be caused by the absence of a complete fusion between the fetal membranes and the decidua. Fibronectin detection in cervicovaginal secretions prior to membrane rupture was a possible marker for impending preterm labor.
The assumption that cervical ripening is intimately related to increased secretion of fFN is derived from experimental observations, indicating fibronectins as important organizers of connective tissue. Its cervical levels are correlated with spontaneous cervical ripening at term.
Against this background, It was hypothesized that fFN in cervicovaginal secretions could be useful to predict a favorable response to misoprostol administration, to induce abortion in mid-trimester.
The study
The present study is a prospective observational study discussing the relation between cervicovaginal fluid level of fetal fibronectin and easiness of induction of midtrimestric missed abortion.
The procedures set out in this study protocol, pertaining to the conduct, evaluation and documentation of this study, were designed to ensure that the investigators abide by the principles of good clinical practice (GCP). For ethical and research approval, the protocol and all corresponding documents were declared and approved by the Council of OB/GYN Department, Ain Shams University. The study was performed in Ain Shams University Maternity Hospital in a six months period.
The study included women with midrimestric missed abortion who were planned for induction of abortion. 135 pregnant women were included according to inclusion and exclusion criteria. The exclusion criteria included (Contraindication to medical termination of pregnancy (e.g.: low lying placenta), presence of IUD in situ, Evidence suggesting onset of spontaneous abortion (e.g.: vaginal bleeding, cervical dilatation or effacement, or any uterine activity), Presence of ruptured membrane and / or suspicious of septic abortion, Previous trial to induce abortion or the use of pre induction medication in the current pregnancy, Multifetal pregnancy, Polyhydraminos, Previous caesarean section or other uterine surgery or perforation, Cervical cerclage during current pregnancy, Previous cauterization of cervical erosion, Previous cervical dilatation, Vaginal or cervical infection, Mental condition rendering the patient unable to understand the consequences of the study).
Cervicovaginal secretion was collected from posterior vaginal fornix, and the specimens were placed in sterile plastic containers, stored at -20C° until assayed with an Enzyme-Linked Immuno Sorbant Assay, to measure the level of fetal fibronectin.
Later on, induction was performed using misoprostol 800mcg vaginally, then misoprostol 400 meg vaginally, 4 hourly, to a maximum of five doses in the first 24 hours. If a woman did not have adequate uterine contractions within 8 hours following the last dose, The same regimen was repeated over the following 24 hours, and if no response was achieved, this was considered a failure of therapy, and an alternative interventions was carried out on the basis of judgment of the clinicians.
The Results
In the included 135 women, 3 (2.2%) did not Abort for which they were excluded from this study, 119 (88.1 %) Aborted within 24 hours, While 13 (9.6%) needed 24-48 hours to abort the fetus.
There was no significant difference between women who expulsed the fetus within 24 hours and women who did not regarding cervicovaginal fetal fibronectin 7.7-39.3, 10 (8.4%), (P >0.05), also, There was no significant difference between women who expulsed the fetus 24-48 hours and women who did not regarding cervicovaginal fetal fibronectin, 11.2 -40.4, 2 (12.5%) (P >0.05) respectively.
ROC curve was constructed for cervicovaginal fetal fibronectin as predictor of expulsion of the fetus within 24 showed non-significant association and poor predictability [AUC=0.508, 95% CI (0.500-0.663), p>0.05 respectively].
According to a previously set cutoff point of > 50 ng/ml (Mercorio et al., 2005), 12 (8.9%), CI 95% (4.1% – 13.7%) were positive for cervicovaginal FFN.
The mean cervicovaginal fetal fibronectin in included women was 39.4 ± 7.9 ng/ml (range: 15 - 60 ng/ml).
There were no significant correlation between cervicovaginal fetal fibronectin and induction-to-onset of contraction, onset of contraction to expulsion and induction-to-expulsion intervals [r=0.103, p>0.05; r=-0.049, p>0.05, respectively]
There was no significant correlation between cervicovaginal fetal fibronectin and total dose of misoprostol [r=-0.090, p>0.05].
There were no significant correlation between cervicovaginal fetal fibronectin and each of maternal age, BMI. There were significant negative correlation between cervicovaginal fetal fibronectin and GA.
The results of the current study clearly show that the presence of fFN in cervical secretions in the 2nd trimester of pregnancy was not useful to predict induction outcome. As a consequence, we could not find evidence that fFN facilitates a favorable cervical state, and therefore cannot be proposed as a screening method to detect successful induction.