QUIDS - using fibronectin to find out which women with symptoms of preterm labour are at risk

Sarah Stock, Jane Norman, Andrew Shennan, John Norrie Kathleen Boyd, Ben Mol Susan Harper-Clarke, Irene Brady, Tina Lavender, Khalid Khan, Rachel Morris, Manju Chandiramani, Asma Khalil, Lesley Jackson, Jon Dorling, Richard Riley

Researchers in our Edinburgh centre are working on a new, more accurate test for predicting premature birth.

Up to 80% of women who have signs of premature labour – like contractions or stomach pain – are still pregnant after 7 days. However, it is very difficult to tell which of these women are actually at risk of premature birth. A lot of women are treated ‘just in case,’ as doing nothing could have devastating consequences.

A test called quantitative fetal fibronectin (fFN) could help change this.

Fetal fibronectin is a special protein made by babies’ cells in the womb, and acts as a 'glue' that keeps the amniotic sac attached to the lining of the womb.

The protein can be tested by taking a swab, which is analyzed to give results in less than ten minutes. The lower the concentration of fFN, the less likely a woman is to give birth early.

A test that simply gives a positive or negative result has been available for a while. However, this new test could rule out preterm labour more accurately than ever. In work funded by the National Institute for Health Research, Tommy’s researchers have looked at earlier studies to find out if a more accurate fetal fibronectic test is likely to be useful. They have also looked at which other clinical factors could be used together with the test to best diagnose premature labour.

Predicting premature birth

The main aim of this research is to see if fFN can accurately rule out preterm delivery within 7 days of testing. We have asked women, their partners and their caregivers which things are most important when making decisions about preterm birth treatment, and how best to present information to support decision making.

This ensures the QUIDS research is relevant to them. We have then analysed previous research data to see if qfFN is likely to be a useful test - either on its own, or in combination with clinical features that may increase the likelihood of preterm delivery (such as history of previous preterm labour or twin pregnancy). We have used this data to determine which combination of features can help diagnose preterm labour most effectively, whilst still being good value to the NHS.

In order to ensure that this 'model' works in UK populations, we are now trialing using it to predict preterm delivery in women attending 26 UK maternity units with symptoms of preterm labour. We will then adapt it as necessary for NHS use. We use our findings to develop decision support tool, to help women and clinicians assess how likely preterm delivery is, and decide whether to start treatment or not. We will make the decision support freely available, most likely as a web-based application.

Timing

2015-2019

Research papers

  • Stock SJ, Wotherspoon LM, Boyd KA, Morris RK, Dorling J, Jackson L, Chandiramani M, David AL, Khalil A, Shennan A, Hodgetts Morton V, Lavender T, Khan K, Harper-Clarke S, Mol B, Riley RD, Norrie J, Norman J. Study protocol: quantitative fibronectin to help decision-making in women with symptoms of preterm labour (QUIDS) part 2, UK Prospective Cohort Study. BMJ Open. 2018 Apr 19;8(4):e020795. doi: 10.1136/bmjopen-2017-020795.
  • Stock SJ, Wotherspoon LM, Boyd KA, Morris RK, Dorling J, Jackson L, Chandiramani M, David AL, Khalil A, Shennan A, Hodgetts Morton V, Lavender T, Khan K, Harper-Clarke S, Mol BW, Riley RD, Norrie J, Norman JE. Quantitative fibronectin to help decision-making in women with symptoms of preterm labour (QUIDS) part 1: Individual participant data meta-analysis and health economic analysis. BMJ Open. 2018 Apr 7;8(4):e020796. doi: 10.1136/bmjopen-2017-020796.

 


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Funding

This study takes place in a Tommy's centre and is funded by the National Institute for Health Research's Health Technology Assessment programme

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