The Politics of the Fetal Fibronectin Test

by Jen on April 2, 2008

in Does this baby make me look fat?

At my six week post-partum check-up after the Monkey’s birth, I asked my OB what the chances are that I could deliver prematurely again. He guessed (and admitted it was sort of a guess) that my chances of having the same thing happen again were further increased only by about 10%.

“But there’s a test we can do next time that will let us know if you have an increased risk of delivering early.”

At that time two and a half years ago, I had only just heard of the Fetal Fibronectin (fFN) Test, but I assumed that was what he was talking about. So I left it at that, knowing we’d revisit the subject when it became relevant. Of course, once I became pregnant again, I started doing my own research before I even talked to my doctor about it.

Fetal fibronectin is the “glue” that attaches the fetal sac to the uterine lining. It can be present in vaginal secretions before 22 weeks gestation and after 35 weeks, but between 22 and 35 weeks it can be a signal that the bond between between the two is starting to break down and that pre-term labor may be imminent. May. Be. The most interesting fact of all is that a positive result doesn’t necessarily mean anything. Other than that you will deliver a baby at some point before the end of time.

A negative result, on the other hand, is a fairly good predictor that you won’t deliver within the next two weeks (although I do know of a woman who did deliver early after a negative test, as the test is only about 95% accurate — although the company that makes the test reports it as 99.2% accurate).

So, of course, I asked my doctor about if he was still planning on using the fFN test. This was at my twenty week appointment where he checked my cervical length, as well as testing me for infections again — all part of the slightly increased vigilance this time around. Interestingly, in the two and a half years since we had that conversation, his attitude about the test had changed.
His opinion is that the test is of limited value. The information that a positive test provides to medical professionals isn’t very reliable or helpful. And that the information a negative test provides is merely just reassurance, not medically helpful. His (near)exact words were

Insurance companies love this test, because it allows them to force women who may be showing signs of pre-term labor out of the hospital, therefore saving them money. That’s where the value in the test lies.

But he offered to start doing the test if it was what I wanted and if it would make me feel better. Since I could find very little information as to whether it was reliable regarding pPROM, and since I trust my doctor a great deal, I told him that it was up to him, that I trusted him, and that if he didn’t think it was of value in my case, then we could skip it. A month later, at my 24 week appointment, the PA told me that she wanted to talk to the doctor about doing the fFN test soon. I didn’t bother to tell he what he had just told me — I figured they could have their own conversation, since they both know a lot more about pregnancy and childbirth than I do.* Yet another month later, as I checked out after my 28 week appointment, the nurse told me that my next appointment at 32 weeks would be with the PA, and that it would involve another internal, as they’d be checking my cervix, running cultures again to check for infections and “doing the test for pre-term labor.”

Since the test doesn’t actually hurt anything, I didn’t question it. And after seeing the NICU bill for the Monkeyboy’s stay, I’m sure my insurance will be glad to cover the $200 that the test costs. But I wonder what was said during the meeting of the medical minds that made them decide to do the test after all.

*Although, come to think of it, he’s a man, and she’s a young women who I don’t believe has any children yet, so I bet I have a few bits of knowledge that they don’t have.

Leave a Comment

You can use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

CommentLuv Enabled

Previous post:

Next post: