Development and validation of a tool incorporating cervical length and quantitative fetal fibronectin to predict spontaneous preterm birth in asymptomatic high-risk women

Read the article: Development and validation of a tool incorporating cervical length and quantitative fetal fibronectin to predict spontaneous preterm birth in asymptomatic high-risk women
Published 5 January 2016.

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Comment from author, Prof. Andrew Shennan
London, UK

'Managing and preventing preterm birth remains a major challenge in obstetrics, which causes not only substantial clinical impact but also considerable psychological and financial burden. Most preterm deliveries are due to spontaneous labor, and prediction of those destined to deliver early is key for targeted intervention. There have been significant advances in our understanding of measures to reduce preterm delivery in high-risk women, including vaginal progesterone, cervical cerclage and, more recently, Arabin pessaries. In those likely to deliver, presenting with threatened preterm labor, correctly targeting antenatal steroids reduces unwanted side effects (e.g. fetal weight loss from inappropriate dosage in those that fail to deliver within 7 days) while optimizing benefit if given close to delivery. The use of magnesium sulphate near to delivery can also ameliorate neurological morbidity in the newborn. Tocolysis is sometimes used to facilitate in-utero transfer. All these interventions require judicious assessment of risk, and, clinically, this has proved challenging. Advances in prediction of preterm birth include the use of cervical length measurement and cervicovaginal fetal fibronectin. However, the results of these variables have often been dichotomized in research papers to aid analysis and demonstrate value; this limits their potential as they are continuous variables with variable risk across the measured range. Clinicians’ judgement of risk is also dependent on knowledge and experience, which is also inconsistent.'

'In the January and February issues of UOG, two studies (Kuhrt et al.) have been published that have optimized prediction (in both symptomatic and asymptomatic women) by combining cervical length and the newly quantifiable fetal fibronectin with clinical features in patient history that add to the algorithm. These have been incorporated into an App (download for free: QUiPP) that accurately calculates risk and presents it as a percentage probability of delivering within certain timeframes from testing (within 1, 2 and 4 weeks) and at a range of gestational ages (30, 34 and 37 weeks). The prediction is far more accurate than using the parameters alone and removes the variability of clinicians’ interpretation. The validation sets in both studies confirm the value and generalizability of the prediction tool. The challenge now is to link interventions to the improved knowledge of risk obtained from such tools.'

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