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|New app helps doctors predict preterm birth
A new app called QUiPP can help doctors better identify women at risk of giving premature birth. Developed at King's College London, the app was tested in two studies of high-risk women monitored at ante-natal clinics.
Worldwide 15 million babies are born before 37 weeks (preterm) each year. Over a million of these die of prematurity-related complications. A number of factors are used to determine a woman at risk for premature birth, including previous preterm births or late miscarriages. Two other factors to be considered are the length of cervix and levels of a vaginal fluid biomarker known as fetal fibronectin, if tested from 23 weeks onward.
The app developed at King's uses an algorithm combining gestation of previous pregnancies and cervix length and levels of fetal fibronectin to classify a woman's risk. The first study focused on women at high risk of preterm birth, because of a previous early pregnancy — without showing any symptoms. The second study predicted likelihood of early delivery in women with symptoms of early labour — which often didn't progress to real labour.
In the first study, published in the journal Ultrasound in Obstetrics & Gynecology1, researchers collected data from 1,249 women at high risk for pre-term birth attending pre-term surveillance clinics. The model was developed on the first 624 consecutive women and validated on the subsequent 625. The estimated probability of delivery before 30, 34 or 37 weeks' gestation and within two or four weeks of testing for fetal fibronectin was calculated for each patient and analyzed as a predictive test for the actual occurrence of each event.
In the second study, also published in the same issue of the journal Ultrasound in Obstetrics & Gynecology2, data from 382 high-risk women was collected. The model was developed on the first 190 women and validated on the remaining 192. Probabilities of delivering early were estimated as above.
In both studies, the app was found to perform well as a predictive tool, and far better than each single component (previous pregnancy, cervical length or fetal fibronectin) alone.
Professor Andrew Shennan, lead author, Professor of Obstetrics at King's College London and consultant obstetrician at Guy's and St Thomas' NHS Foundation Trust, adds: "Despite advances in prenatal care, the rate of preterm birth has never been higher in recent years. In the US and UK, doctors need reliable ways to predict whether a woman is at risk of giving birth early. It can be difficult to accurately assess a woman's risk, given many women with symptoms of preterm labour do not deliver early.
"The more accurately we can predict her risk, the better we can manage a woman's pregnancy to ensure the safest possible birth for her and her baby — only intervening when necessary to admit 'higher risk' women to hospital, prescribe steroids or offer other treatments to prevent an early birth."
Abstract1: Development and validation of a tool incorporating cervical length and quantitative fetal fibronectin to predict spontaneous preterm birth in asymptomatic high-risk women
Abstract2: Development and validation of a tool incorporating cervical length and quantitative fetal fibronectin to predict spontaneous preterm birth in asymptomatic high-risk women