Study Examines The Effectiveness Of A Test To Detect The Onset Of Preterm Birth

Found on the Medical News Today website
Originally published December 9, 2009

Less than 50% of women with threatened preterm labour actually deliver when they present at hospital. However, for many of these women, antenatal admissions are common and many are subjected to unnecessary interventions. New research to be presented at the 8th RCOG International Scientific Meeting reveals how a simple test helps to determine if women showing signs of preterm birth will in fact not deliver early.

Fetal fibronectin (fFN) is the protein which helps attach the fetal sac to the uterus. Previous research has shown that when fFN is found to be leaking at a certain stage of pregnancy, a spontaneous preterm birth is more likely. A diagnostic fFN test has been developed though it is not commonly used in all maternity units. Relatively cheap and easy to perform, the test is done at the same time as a vaginal examination, which is routine when a woman is admitted with abdominal pain in pregnancy. A negative result means fetal fibronectin is minimally present and the chance of the woman having an imminent preterm birth is low.

The researchers from University College London and University College Hospital London conducted a two-stage audit to assess the effectiveness of the fFN test and the impact of its introduction.

Over a two-month period, there were 95 hospital admissions that were at <37 weeks gestation. Out of 22 women (23%) who presented with threatened preterm labour, 17 (78%) did not deliver during their admission. 16 of these women received steroids (to improve the baby's lung function) or tocolytic drugs (to halt the contractions which bring on labour) and three women had an in-utero transfer to a hospital with neonatal cots available. The mean duration of hospital stay was 8.1 days.

After introducing the fFN test, in 94 of the tests carried out, the negative predictive value for delivery within two weeks was 98.6%. Of the 78 women in threatened preterm labour with negative fFN, only seven were admitted for management of abdominal pain.
Dr Anna David, consultant obstetrician at UCLH and the UCL Institute for Women's Health, who led the study said "Threatened preterm labour often causes much anxiety for pregnant women. Doctors are working hard to uncover the causes of preterm birth and to develop preventive treatments.

"In the meantime, the fetal fibronectin test has been found to be very accurate at predicting those women who will not imminently deliver. Women with a negative test can be reassured that they do not need inpatient care. They can therefore avoid leaving their families for observation in a hospital, though a few may need admission for pain relief. More importantly, unnecessary drug interventions can be prevented which could translate into significant cost savings to the NHS.

"Based on the results of our study, the use of fFN tests can also reduce unnecessary in-utero transfers, which at this time of neonatal unit cot shortages is a huge advantage."

Notes

The Royal College of Obstetricians and Gynaecologists 8th International Scientific Meeting is taking place in Abu Dhabi, the United Arab Emirates, from Monday 7 to Wednesday 9 December 2009. The meeting is held in collaboration with the Abu Dhabi Health Services Co. (SEHA) and sponsored by the Abu Dhabi Tourism Authority. For more information about the meeting, please click here.

About UCL Elizabeth Garrett Anderson Institute for Women's Health

The Institute is a joint venture between UCL (University College London) and University College London Hospitals NHS Foundation Trust (UCLH) and brings together individuals with expertise across the whole spectrum of women's health - from laboratory science to clinical skills to social and behavioural sciences - with the objective of making a major contribution to the health of women, both in the UK and internationally, by pioneering research, education programmes and clinical initiatives.

SourceRoyal College of Obstetricians and Gynaecologists