***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To examine how the availability of fetal fibronectin testing affects the utilization of hospital re sources . METHODS A comparison of the rates , duration , and costs of hospitalization for a prospect i ve cohort of women who presented with preterm labour after fetal fibronectin ( Ffn ) testing became available , and a historical baseline cohort who presented with preterm labour before fetal fibronectin testing was available . The study included singleton pregnancies presenting between 24 and 34 weeks ' gestation with signs and symptoms of preterm labour . The women in each study cohort presented during a design ated 20-week period . RESULTS We examined the records of 116 subjects with comparable gestational age distributions in each 20-week period . During the study period when Ffn testing was available , 51 tests were performed . Four tests were invalid , and 12 subjects who were tested did not meeting the inclusion criteria . Admissions for preterm labour in the study period were significantly less than in the baseline cohort ( 12.1 % vs. 24.1 % , P = 0.03 ) , with no difference in preterm births ( 8.6 % vs. 7.8 % ) . The mean length of stay per patient with preterm labour declined from 5.2 days to 0.6 days ( P < 0.0001 ) , and the mean cost per patient with preterm labour declined from $ 3666 to $ 581 ( P < 0.0001 ) . In the 20-week study period , there was a reduction in total length of hospital stay from 145 to 28 days , with an overall reduction in total cost from $ 102 660 to $ 26 169 . CONCLUSION The availability of Ffn testing was associated with a reduction in hospital admissions , length of hospital stay , and overall hospital costs in the management of threatened preterm labour OBJECTIVE : To assess the impact of activity restriction ( AR ) on the incidence of preterm birth in women treated for preterm labor testing negative for fetal fibronectin ( fFN ) . STUDY DESIGN : Women who were diagnosed with preterm labor and tocolyzed with magnesium sulfate were concurrently screened with fFN for the purpose of subsequent management . Included were consenting patients with negative fFN , gestational age 23 0/7–33 6/7 weeks , cervical dilation ≤3 cm , and minimal vaginal bleeding . Patients were r and omized to AR or no AR . Primary study outcome was incidence of preterm delivery and interval from r and omization to delivery . RESULTS : A total of 73 women with negative fFN were r and omized ( 36 with AR , 37 without AR ) . The overall preterm birth rate was 40 % , with 44.4 % of patients with AR and 35.1 % of patients without AR delivering preterm , p=0.478 . CONCLUSION : Maternal AR did not impact pregnancy outcome . The incidence of preterm birth in symptomatic women testing fFN negative was higher than previously reported This week , a series of four articles considers the place of the r and omised controlled trial as we approach the second century of experience with the concept . Its basic principle is genuine uncertainty as to which treatment arm of the trial it would be in a patient 's best interests to enter . This is not necessarily an easy concept to transmit , OBJECTIVE We sought to investigate if determination of cervicovaginal interleukin-6 ( IL-6 ) levels would enhance the positive predictive value of fetal fibronectin ( fFN ) for preterm birth . METHODS A prospect i ve cohort study was undertaken of 135 women between 24 and 34 weeks gestation with symptoms of suspected preterm labor .  Cervicovaginal secretions were collected for both IL-6 and fFN and measured by immunoassay and ELISA , respectively . Outcome variables included preterm delivery in less than 48 h , within 7 days , and prior to 37 weeks . Statistical analysis was performed with Fisher 's exact test , regression for logarithmic transform levels , and multivariate logistic regression . ROC curves were created for IL-6 levels . RESULTS IL-6 and fFN levels were both elevated in cervicovaginal secretions of women with symptoms of preterm labor . IL-6 values > 100 pg/ml result ed in a odds ratio for delivery at < 37 weeks of 1.57 ( 95%CI=0.89 - 2.75 , P=.11 ) , whereas fFN values > 50 ng/ml result ed in a preterm delivery risk of 4.58 ( 95%CI=1.54 - 13.35 , P=.003 ) . Combining IL-6 and fFN results did not improve upon the predictive value of fFN alone for preterm birth [ odds ratio 4.00 ( 95%CI=1.31 - 12.17 , P=.015 ) ] . CONCLUSION Cervicovaginal IL-6 levels did not provide any additional , independent effect on the prediction of preterm birth beyond that of fFN testing alone Aims The purpose of this pilot study was to determine the role of foetal fibronectin ( fFN ) testing in women presenting to hospital with symptoms of preterm labour in reducing the hospital admissions , without significantly increasing the risk of preterm birth and neonatal respiratory distress syndrome . Methods Women with symptoms of preterm labour were assigned r and omly to receive  fFN ( n = 44 ) or to  preterm labour management without fFN ( n = 44 ) . In the testing arm , the result of the test was revealed to the clinician . Clinical outcomes were compared in the two groups . The time period covered by the r and omised controlled trial ( RCT ) was from December 2007 to March 2009 . The RCT was conducted in two large maternity units in the west of Scotl and , one in Glasgow the other in Ayrshire . Results All the women with fibronectin positive got admitted while only 32.4 % of the fibronectin negatives were admitted ( P = 0.002 ) . There was a significant difference in the mean length of stay between the fibronectin positives which was 47.17 h , and the negatives which was 12.9 h ( P = 0.018 ) . Overall the control and testing arms did not differ in respect to admissions and length of stay . 5 out of 7 positives and 11 out of 37 negatives had corticosteroids ( P = 0.089 ) . 2 out of 7 positives and 1 out of 37 negatives had tocolytics ( P = 0.073 ) . Conclusions Those who had the fFN test done were less likely to be admitted in the hospital and had a shorter length of stay , without any increase in the adverse maternal or foetal effects , avoiding unnecessary admissions OBJECTIVE To assess the clinical value of cervicovaginal fetal fibronectin ( FFN ) in the prediction of preterm delivery ( PTD ) in women with signs and symptoms of preterm labor ( PTL ) . METHOD This investigation prospect ively studied a cohort of a women with symptoms of PTL , between 24 and 37 weeks ' gestation with < 3 cm of cervical dilatation and intact membranes . Cases were evaluated in terms of maternal demographic characteristics like age , body mass index , number of parities , previous PTL history , Bishop scores at admission , gestational age at delivery , mode of delivery , use of tocolytic or steroids , presence of histologic chorioamnionitis , neonatal outcomes and delivery before 34 weeks ' gestation  as well as within seven days of admission . RESULTS A total number of 68 cases were included in the study . There were no statistically significant differences between positive and negative FFN groups in terms of maternal characteristics , mode of delivery and adverse neonatal outcomes . However , FFN + cases had higher Bishop scores on admission ( 3.4 + /- 1.2 vs 2.5 + /- 0.3 , p = 0.03 ) and lower gestational age at delivery ( 33.4 + /- 3.1 weeks vs 36.8 + /- 2.1 weeks , p = 0.002 ) . Likelihood ratio ( LR ) for positive results was 1.83 ( 95 % CI : 1.61 - 2.26 ) for predicting birth before 34 weeks ' gestation , with a corresponding negative LR of 0.62 ( 95 % CI : 0.3 - 1.2 ) . LR for positive results was 4.34 ( 95 % CI : 3.65 - 5.12 ) for predicting birth within seven days of testing , with a corresponding negative LR of 0.3 ( 95 % CI : 0.2 - 0.5 ) . CONCLUSION Based on the results of cervicovaginal FFN , positive tests represent an increased likelihood of PTD among women with symptoms of threatened preterm labor OBJECTIVE The purpose of this study was to codify the relationship between bacterial vaginosis/fetal fibronectin and preterm labor/birth . STUDY DESIGN In this prospect i ve study , 185 women who were symptomatic for preterm labor were assessed for bacterial vaginosis and fetal fibronectin . RESULTS These women comprised 4 groups : group A ( n=23 women ; + bacterial vaginosis/+fetal fibronectin ) ; group B ( n=31 women ; -bacterial vaginosis/+fetal fibronectin ) ; group C ( n=47 women ; + bacterial vaginosis/-fetal fibronectin ) ; and group D ( n=84 women ; -bacterial vaginosis/-fetal fibronectin ) . The time interval from gestational age at testing until delivery was significantly shorter for groups A and B versus groups C and D ( P < or = .05 and P < .001 , respectively ) . Similarly , delivery at < 32 weeks of gestation was increased in group B ( 26 % ) compared with groups A ( 9 % ) , C ( 2 % ) , and D ( 5 % ; P < .009 ; odds ratio , 165.90 ; 95 % CI , 30.02 , 916.08 ) . CONCLUSION Women who are symptomatic for preterm labor should be considered for fetal fibronectin and bacterial vaginosis testing OBJECTIVE Our purpose was to determine whether tumor necrosis factor-alpha , interleukin-6 , and fetal fibronectin could be identified in the lower genital tract during pregnancy and whether their occurrence was associated with preterm delivery . STUDY DESIGN A prospect i ve cohort study was undertaken of 111 pregnant women in which cervicovaginal swabs were obtained at < 37 weeks ' gestation . Seventy-three specimens were obtained from women during routine prenatal examination , whereas 38 specimens were obtained from women undergoing evaluation of preterm labor .  Interleukin-6 and fetal fibronectin levels were determined by enzyme-linked immunosorbent assays , whereas tumor necrosis factor-alpha determinations were by bioassay . Urinary tract and lower genital tract sample s were cultured for evidence of infection . The rates of maternal and neonatal complications were assessed . RESULTS In patients undergoing evaluation for preterm labor the presence of tumor necrosis factor-alpha or fetal fibronectin was associated with an increased prevalence of preterm delivery . Women with tumor necrosis factor-alpha had a 6.19 greater risk ( p < 0.005 ) , whereas the presence of fetal fibronectin was associated with a 4.81 greater risk ( p < 0.05 ) , of preterm birth . This association was not evident in women who were sample d during routine prenatal examinations . In all women the presence of cytokines in the lower genital tract correlated with detection of fetal fibronectin . CONCLUSION Localized inflammatory responses may lead to microscopic disruption in the amniotic membranes , leading to leakage of fibronectin . In patients being evaluated for preterm labor , the presence of tumor necrosis factor-alpha or fetal fibronectin in the lower genital tract is predictive of subsequent preterm delivery Objective To assess the accuracy of vaginal fetal fibronectin ( FFN ) as a screening test for preterm delivery in a community hospital . Study design A prospect i ve cohort of patients at high risk for preterm delivery at a community hospital underwent testing with FFN over a 15 month-period ( March 2004–May 2005 ) . Indications for testing were preterm labor , multiple pregnancies , cervical shortening , and cerclage . Pregnancy characteristics were retrieved on all women with positive FFN results and controls in a 1:2 ratio . Outcome variables included interval to delivery ; length of hospital stay ; and rates of preterm delivery < 37 weeks . In the presence of serial FFN testing , only the initial result was used for calculation of diagnostic indices . Statistical analysis utilized t-test , Fisher ’s exact test and logistic regression analyis to control for gestational age at testing , with P < 0.05 or odds ratio ( OR ) with 95 % confidence interval ( CI ) not inclusive of the unity considered significant . Results Two hundred and fifty seven FFN tests were performed in 230 women , of which 33 ( 14.3 % ) had positive FFN results .  Duration of hospital stay was significantly shorter for patients with negative than positive results ( 8 h vs. 2.1 days , P = 0.011 ) . Women with positive FFN were more likely to deliver within 14 days ( OR = 6.5 , 95 % CI 1.4 ; 30.7 ) , within 21 days ( OR = 4.8 ; 95 % CI 1.4 ; 16.6 ) , before 34 weeks ( OR = 5.0 , 95 % CI 1.7 ; 14.8 ) and before 37 weeks ( OR = 3.1 ; 95 % CI 
    Output:
    
Sensitivity analyses indicated that admission rate had the largest impact on results .
CONCLUSIONS Fetal fibronectin testing has moderate accuracy for predicting PTB .
The main potential role is likely to be reducing health-care re source usage by identifying women not requiring intervention .
Evidence from RCTs suggests that fFN does not increase adverse outcomes and may reduce re source use .
The base-case analysis showed a modest cost difference in favour of fFN testing , which is largely dependent on whether or not fFN testing reduces hospital admission .