Why do we need this research?
When a baby is born prematurely, they may need special care in the first few weeks or months of life. They are also more likely to have health problems as they grow up.
If a pregnant woman is showing signs that she might give birth early there are several strategies that doctors can use to try to delay labour or reduce the health risks linked with premature birth. Options include giving steroids to help the baby’s lungs mature and, if necessary, transferring the pregnant woman to a hospital that has a specialist neonatal unit so that her baby does not have to be moved after birth. However, too often a woman might receive treatment or be transferred but not actually end up giving birth early. This unnecessary intervention can put pressure on the health service, and prevents other patients getting the care they need. It can also cause stress and anxiety for the woman and her family.
We need better ways to predict how likely a woman is to go into premature labour so that doctors can give the right care at the right time.
What’s happened in this project?
Researchers supported by Tommy’s developed the QUIPP app, which can help doctors predict how likely it is that a woman will give birth in the next 7 days and therefore decide which women need further medical help, and which don’t. The app works by looking at different measures, including the levels of a protein called fetal fibronectin in the woman’s vagina, the length of her cervix, and any previous history of premature birth.
To find out whether the QUIPP app really is effective at preventing unnecessary treatment or transfer for women with symptoms of premature birth, our researchers set up the EQUIPTT trial. The study took place at 13 maternity units in England, with some sites using the QUIPP app and other sites using standard practice to guide their decision making. Nearly 1,800 women were included in the analysis.
The EQUIPTT study showed that only around 1 in 10 women received inappropriate treatment, regardless of whether doctors used the QUIPP app or standard practice to make decisions about their care. This low level of inappropriate management, even without using the QUIPP app, is likely a result of doctors using fetal fibronectin testing to help them decide what to do. The QUIPP app was shown to be very good at predicting which women were likely to go into labour in the next 7 days and doctors found it to be a valuable tool.
What difference will this project make?
The EQUIPTT study shows that the QUIPP app can help doctors to identify the women who are most at risk of giving birth early. It was also valued by clinicians. Although the proportion of women receiving inappropriate management was low in both the ‘standard care’ and QUIPP groups, the QUIPP app helped to simplify what would otherwise have been a very complex decision about how likely it is that a woman will go into labour early. The app has therefore been recommended for use by NHS England.