Is it necessary to use a speculum for the fetal fibronectin test?

The manufacturer of the fetal fibronectin (fFN) test recommends that the sterile polyester swab be collected during a speculum examination by lightly rotating the swab across the posterior fornix for ~10 seconds to absorb cervicovaginal secretions ^[1].

However, evidence suggests that a speculum exam is not strictly required. A prospective study by Stafford et al. demonstrated excellent agreement between fFN results collected by speculum and two nonspeculum techniques ^[2].

Nonspeculum Techniques Evaluated

1. Finger-guided posterior fornix collection

The clinician inserted the index finger into the vagina, depressed the posterior wall, then advanced the fFN swab along the finger until the swab reached the posterior fornix. The swab remained in place for 10 seconds.

2. “Blind sweep” technique

The labia were separated, and the clinician inserted the swab directly toward the posterior fornix without a guiding finger for 30 seconds.

The study found no significant difference in diagnostic performance between the speculum and nonspeculum methods and could not determine whether one nonspeculum approach was superior.

Thus, while a speculum exam remains the recommended method, a properly performed nonspeculum technique is acceptable when necessary.