Comparison Between Fetal Fibronectin (Ffn) vs Cervical Length in Patient With Unfavourable Cervix in Prediction of Successful Induction of Labor
Condition: Fetal Fibronectin (Ffn)
Study type: Observational

Summary: 
      This study aims to assess the efficacy of fFN compared to transvaginal ultrasound of cervix
      in prediction of successful induction of labor for unfavorable cervix (bishop score 5 or
      less).
    

Detailed description: 
      Induction of labor should be undertaken when the benefits of delivery to either mother or
      fetus outweigh the risks of pregnancy continuation. Many accepted medical and obstetric
      indications for labor induction like Hypertensive disorders, Preeclampsia/ eclampsia,
      Gestational hypertension, Maternal medical conditions, Diabetes mellitus, Renal disease,
      Chronic pulmonary disease, Chorioamnionitis and Oligohydramnios .Sonographic assessment of
      cervical length for predicting the outcome of labor induction has been evaluated in numerous
      studies. The role of ultrasound examination as a tool for selecting women likely to have a
      successful induction is uncertain . transvaginal sonographic measurements of cervical length
      in nulliparous women independently predict the likelihood of progress in nulliparous women
      undergoing labor induction. These observations strongly support the notion that in
      nulliparous women undergoing labor induction preinduction cervical length plays a key role in
      labor progression during the latent phase, but not during the active phase of labor .Entering
      the active phase within 24 hr of induction. On the other hand, cervical length appears to
      poorly predict the likelihood of cesarean delivery for failure to Bishop's score has the
      advantage of being universally known . The cutoff point at which delivery can be induced
      without increasing the risk of cesarean delivery is generally 7 or 6, but this varies from
      one country to another depending on different local guidelines 6 7 8. However, that point is
      rarely reached in reality. What's more, Bishop's score does not include parity, even though
      this variable is known for being closely associated with the induction success. Last, several
      authors have shown that some components of Bishop's score have a low prognostic value for the
      success or the failure of the induction .The Bishop score is a poor predictor for the outcome
      of induced labor at term and should not be used to decide whether to induce labor or not
      .Fibronectin is large glycoprotein (molecular mass about 420kDa) is normally present in
      essentially all tissues and body fluids. Its primary function is its role in cell adhesion
      and phagocytosis .Fetal fibronectin, a glycoprotein thought to act as an adherent at the
      maternal fetal interface, is uncommonly present in cervicovaginal secretions in the late
      second and early third trimesters. Although the risk for preterm birth increases as the level
      of fetal fibronectin rises, it has been evaluated only as a qualitative test, with a value of
      50ng/dL or greater being called positive. A positive test is believed to indicate disruption
      of the maternal-fetal decidual attachment. Asymptomatic women with a positive fetal
      fibronectin test have an increased risk for preterm birth before 35 weeks, especially within
      2 weeks of a positive result. Although the sensitivity of the fibronectin test at 22 to 24
      weeks for all spontaneous births before 35 weeks was only 25%, sensitivity for births before
      28 weeks was 65% in one study .fFN has been proposed as a new tool for cervical evaluation
      before labor induction. fFN in cervicovaginal secretion of term deliveries yield a high
      probability of success of induction women with fibronective negative cervicovaginal secretion
      and unfavorable cervix score induction of labour should not be attempted .
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        patient will be recruited in this study from those attending to obstetric ER of Ainshams
        OB/GYN hospital who are nullipara pregnant women gestational age between 37-42 weeks