Authored or Coauthored by Permanente Clinicians

s of Articles Authored or Coauthored by Permanente Clinicians From the Northwest: Fetal fibronectin: the impact of a rapid test on the treatment of women with preterm labor symptoms Plaut MM, Smith W, Kennedy K. Am J Obstet Gynecol 2003 Jun;188(6):1588-93; discussion 1593-5. OBJECTIVE: The purpose of this study was to determine whether knowledge of the results of a rapid fetal fibronectin test affects treatment decisions during the evaluation and treatment of possible preterm labor. Previous observational studies have suggested that a negative test might help to avoid unnecessary intervention. STUDY DESIGN: This was a randomized study of women who were between 24 weeks and 34 weeks six days of gestation with symptoms of preterm labor and who were seen in three community hospitals. A rapid fetal fibronectin test was performed on all subjects. Patients were assigned randomly to a group whose results were known to physician or to a group whose results were not known. Treatment decisions were at the discretion of the physician. RESULTS: One hundred eight samples were collected between September 2000 and December 2001. There were ten positive fetal fibronectin tests. The overall prevalence of delivery within two weeks for the study population was 2.8%. For women who had negative fetal fibronectin test results, the hospital stay was not significantly shorter when the result was known (6.8 hours) than when it was not known (8.1 hours, p = .35). However, when the physician knew the fetal fibronectin status of women with a negative test result who were observed for >6 hours, the hospital stay was shortened 40%, to 22.7 hours from 37.8 hours (p = .04). CONCLUSION: Fetal fibronectin testing may be able to supplement clinical judgment in the evaluation of the condition of patients with symptoms of preterm labor. The greatest benefit of fetal fibronectin testing might be for the patient whom the physician judges to be at high risk for imminent delivery. In such patients, the knowledge of tion required, mortality, and limb loss. RESULTS: During this study, 822 patients received percutaneous suture devices. Infection developed in six patients (0.7%). The incidence of diabetes in the population undergoing percutaneous suture closure was 219 of 822 patients (26.6%). Three comorbid conditions, noted in multiple patients with infectious complications, included diabetes mellitus, obesity, and placement of a percutaneous suture closure device within the past six months. Invasive femoral endarteritis developed in four patients. Gram-positive cocci predominated in four patients. In one patient with polymicrobial infection catastrophic complications developed, including multiple anastomotic ruptures and hemorrhage. A new method of repair that incorporated double-thickness everted saphenous vein was used in two patients, and safe arterial closure was achieved. There was one late fatality on postoperative day 36. Limb salvage was achieved in all patients. CONCLUSIONS: Femoral endarteritis complicating percutaneous suture closure is a challenging new problem for vascular surgeons and can result in catastrophic complications. Customary techniques that use saphenous vein patch or interposition grafting are not adequate in all circumstances. Successful outcome requires operative exploration in patients with suspected infection. Removal of the percutaneous suture closure device and debridement to normal arterial wall is recommended in all patients with suspected femoral endarteritis, based on positive intraoperative Gram stains or abnormal appearance of the adjacent femoral artery. Early success with an autologous bolstered repair is reported. Caution is advised when considering the use of a percutaneous suture closure device in patients with comorbid conditions including diabetes, obesity, and previously implanted devices. Reprinted from Journal of Vascular Surgery, Volume 38, Copyright 2003, Whitton Hollis H Jr, Rehring TF, Femoral endarteritis associated with percutaneous suture closure: new technology, challenging complications, p 83-7, with permission from The Society for Vascular Surgery and the American Association for Vascular Surgery. a negative fetal fibronectin may shorten the