Quantitative fetal fibronectin to predict spontaneous preterm delivery after laser surgery for twin-twin transfusion syndrome

Sci Rep. 2019 Mar 14;9(1):4438. doi: 10.1038/s41598-019-41163-8.


Our goal was to assess whether quantitative fetal fibronectin (qfFN) is associated with spontaneous preterm birth (sPTB) after laser surgery for twin-twin transfusion syndrome (TTTS). qfFN was collected within 24 hours before and after laser surgery. Aims were: (1) To determine if qfFN changed with operative fetoscopy; and (2) To estimate the number of patients needed to study the predictive value of qfFN for sPTB <28 and <32 weeks. Results are reported as median (range). Among 49 patients, there was no net difference in qfFN levels after laser surgery [0.0 ng/mL (-37 to +400), p = 0.6041]. However, patients with a qfFN increase >10 ng/mL were 19 times more likely to undergo sPTB at <28 weeks (OR = 19.5). We determined that 383 and 160 patients would be needed to achieve adequate statistical power for qfFN to be predictive of sPTB at a GA <28 weeks and <32 weeks, respectively. In conclusion, laser surgery did not alter the qfFN level within the entire cohort, but qfFN may be useful in identifying a subset of patients at increased risk of preterm delivery.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Fetofetal Transfusion / surgery*
  • Fibronectins / metabolism*
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / diagnosis*
  • Infant, Newborn, Diseases / etiology
  • Infant, Newborn, Diseases / metabolism
  • Infant, Newborn, Diseases / pathology
  • Laser Therapy / adverse effects*
  • Pregnancy
  • Pregnancy, Twin
  • Premature Birth / diagnosis*
  • Premature Birth / etiology
  • Premature Birth / metabolism
  • Premature Birth / pathology
  • Prospective Studies
  • Twin Studies as Topic


  • Fibronectins