Introduction:

Fetal Fibronectin (fFN) is a glycoprotein produced by the uterine chorionic membranes and is localized to the deciduas basalis adjacent to the intervillous space. Its primary purpose appears to be that of an adhesion molecule (tissue glue) which helps bind the chorionic membranes to the underlying maternal deciduas during pregnancy.

It is normally found in the cervico-vaginal secretions during pregnancy until 22 weeks gestation but is virtually never found between 24 and 34 weeks gestation unless the cervix has undergone premature effacement and dilatation, usually in association with symptomatic uterine contractions. It can also be released in response to inflammation or separation of amniotic membranes from the deciduas. There is a strong association between the presence of Fetal Fibronectin in cervico-vaginal secretions and preterm labour after 24 weeks gestation.

In the past, women presenting with signs of preterm labour were clinically assessed by their health care provider, and if deemed to be in preterm labour, were either admitted to the hospital or, if requiring a higher level of care than provided by that hospital, were transferred to either a level 2 or level 3 perinatal unit. Many of these women were transferred to hospitals far from their homes and sometimes out of the country, if antenatal beds were not available in Ontario.

Since the assessment of preterm labour is difficult to accurately determine, many of these women recovered from their symptoms and were subsequently discharged home without giving birth prematurely.

In the spring of 2008, the Ministry of Health and Long Term Care approved funding for Fetal Fibronectin Testing for all hospitals in Ontario. Use of the fFN test will assist clinicians to determine which women require transfer to level 2 or tertiary centres, decrease unnecessary admissions and make better use of scarce tertiary maternal services.

 Implementation of Fetal Fibronectin Testing in Ontario:

Using a regional network approach, the Ministry of Health contracted with the Child Health Network for the Greater Toronto Area to coordinate the implementation of fFn testing. Five Regional Coordinators, covering the entire Province of Ontario, were appointed and met together in Toronto in March of 2008 to plan the implementation. This website will serve to augment the education provided by Hologic (the fFN vendor), and to provide 24/7 access to information for health care providers in Ontario hospitals.

 Fetal Fibronectin Education:

In addition to education provided at each hospital during the implementation of the test, the Provincial Council for Maternal and Child Health agreed to host this website to provide access to fFN education at all times.

This website provides the following educational resources:

1. A Power Point presentation that can be viewed on-line or downloaded for use by any health care provider/educator. (PPT - 1.47MB)
2. A video of a presentation by Dr. Graeme Smith on Fetal Fibronectin
3. The Ministry of Health Guideline for Fetal Fibronectin Testing (PDF - 293KB)
4. A generic Policy and Procedure that hospitals can use as  template for developing a hospital specific policy and procedure (PDF - 282KB)
5. A patient handout on Fetal Fibronectin testing (PDF - 207KB)
6. A video demonstrating the process for collecting the specimen and performing the test (from Hologic)
7. A pre-test and post test that can be used by hospital staff to test their knowledge prior to and after education on fetal fibronectin testing (PDF - 26KB)
8. A Fetal Fibronectin Utilization Tracking Tool to enable hospitals to track usage of fFN in their hospitals (XLS - 110KB) / Tracking Tool Guidelines (PDF - 52KB)

French Language Guidelines

• L’analyse Fibronectine Foetale Pour le Travail Préterme (PDF - 214KB)
• Algorithme: Fibronectine foetalePatiente (PDF - 177KB)

Fetal Fibronectin Regional Coordinators:

For additional information, please contact your Fetal Fibronectin Regional Coordinator: