Why do we need this research?
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 a baby’s cells that acts as a 'glue' that keeps the amniotic sac attached to the lining of the womb. If birth is imminent, this protein leaks out into the vagina and can be detected by taking a swab, which is analysed to give results in less than ten minutes. A test that simply gives a positive or negative result has been available for a while. However, it is now possible to detect the exact concentration of fFN in the sample; the lower the concentration, the less likely a woman is to give birth early.
What happened in this project?
In work funded by the National Institute for Health Research, researchers at The Tommy’s Centre for Maternal and Fetal Health in Edinburgh have been working with clinicians from around the UK to find out whether this new, more accurate fFN test can be combined with other warning signs of premature birth to predict which women are most likely to give birth within 7 days of testing.
The researchers asked women, their partners and their caregivers about the things that are most important to them when making decisions about preterm birth treatment, and how best to present information to support decision making. They then looked at earlier studies to find out if a more accurate fetal fibronectin test is likely to be useful. They also explored which other clinical factors – such as history of previous preterm labour or twin pregnancy – could be used together with the test to most effectively predict premature labour.
In order to ensure that this predictive 'model' works, the researchers next trialled it in women with symptoms of preterm labour who attended 26 maternity units in the UK. The model was excellent at predicting which women would go into labour spontaneously in the next 7 day.
What difference will this project make?
Our researchers have developed a model that can be used by clinicians to assess how likely preterm delivery is, therefore helping them decide whether to start treatment or not. Once the use of this model has been implemented, it should be possible to make sure that the right women get the support they need, while preventing other women from being treated unnecessarily.