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. 2017 Oct 3:9:585-594.
doi: 10.2147/CEOR.S141061. eCollection 2017.

Utilization of fetal fibronectin testing and pregnancy outcomes among women with symptoms of preterm labor

Sean C Blackwell  1 , Erin M Sullivan  2 , Allison A Petrilla  2 , Xian Shen  2 , Kathleen A Troeger  3 , James D Byrne  4
Affiliations

Utilization of fetal fibronectin testing and pregnancy outcomes among women with symptoms of preterm labor

Sean C Blackwell et al. Clinicoecon Outcomes Res. .

Abstract

Objectives: To identify pregnant health plan members triaged through the emergency department (ED), including labor and delivery (ELD) units, with symptoms of preterm labor (PTL), and evaluate the use of fetal fibronectin (fFN) testing; and to calculate the rate of hospitalization and timing of delivery in relation to the ED visit.

Methods: Retrospective cohort study using Medical Outcomes Research for Effectiveness and Economics Registry®, a national multipayer claims database. A cohort of pregnant women evaluated in an ELD with a diagnosis of PTL from June 2012 through November 2015 was identified. The proportion of women with PTL who received fFN testing was calculated.

Results: A total of 23,062 patients met the criteria for inclusion in the study. The rate of fFN testing prior to delivery was 12.0%. Of the 23,062 patients included in the analysis, 75.9% were discharged home. Of those who were discharged from the emergency room, one in five went on to deliver within 3 days and almost 96% of this group was not screened for the presence of fFN. Of the remaining 24.1% of patients admitted to the hospital, 91.3% delivered during their stay. In a sensitivity analysis, the percentage of women who delivered within 3 days of the ELD encounter was lower for women who received fFN testing only (6.6%) versus those who had a history of transvaginal ultrasound (TVUS) only (21.6%). Furthermore, the rate of delivery within 3 days was lowest among patients who had both fFN testing and TVUS (4.7%).

Conclusion: The utilization of fFN testing is 12%. The majority of pregnant patients triaged through the ELD with symptomatic PTL do not receive an fFN test. As part of PTL evaluation, fFN testing may identify women at increased risk for preterm delivery and help determine appropriate patient management.

Keywords: emergency department; fetal fibronectin testing; pregnancy; preterm labor.

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Conflict of interest statement

Disclosure EMS, AAP and XS are employees of Avalere Health, LLC which received funding from Hologic, Inc. to support the execution of this study and development of the paper. KAT is an employee of Hologic, Inc. SCB and JDB serve as medical experts but received no support for their participation in this paper. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Schematic of study design. Abbreviations: dx, diagnosis; ELD, labor and delivery; PTL, preterm labor.
Figure 2
Figure 2
Study cohort identification. Abbreviations: ELD, labor and delivery; PTL, preterm labor.
Figure 3
Figure 3
Prenatal fFN by type of insurance. Abbreviation: fFN, fetal fibronectin.
Figure 4
Figure 4
ELD triage status, timing of infant delivery and use of fFN testing. Abbreviations: ELD, labor and delivery; fFN, fetal fibronectin.
Figure 5
Figure 5
Sensitivity analysis: fFN and TVUS testing and time to delivery among patients discharged from ELD (N=17,512). Note: Sensitivity analysis: fFN and TVUS testing among patients discharged from ELD who delivered within 3 days (N=17,512). Abbreviations: ELD, labor and delivery; fFN, fetal fibronectin; TVUS, transvaginal ultrasound.
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References

    1. Hamilton BE, Martin JA, Osterman MJK, et al. National Vital Statistics Reports. 12. Vol. 64. Hyattsville, MD: National Center for Health Statistics; 2015. Births: Final data for 2014. - PubMed
    1. Jacob J, Lehne M, Mischker A, Klinger N, Zickermann C, Walker J. Cost effects of preterm birth: a comparison of health care costs associated with early preterm, late preterm, and full-term birth in the first 3 years after birth. Eur J Health Econ. 2016 Dec 1; Epub. - PubMed
    1. OECD . Infant mortality rates (indicator) 2017. Mar 24, 2017. - DOI
    1. Preterm Birth. Centers for Disease Control and Prevention; [Accessed on 28 August 2017]. Accessible at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth....
    1. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics Practice bulletin no. 171: management of preterm labor. Obstet Gynecol. 2016;128(4):e155–e164. - PubMed