Management, Utilization, and Outcomes of Preterm Labor in an Integrated Health Care System

Area of Science:

• Maternal-fetal medicine
• Neonatal outcomes
• Healthcare economics

Background:

• Spontaneous preterm birth (sPTB) poses significant risks to neonates, including respiratory distress syndrome (RDS) and NICU admission.
• Fetal fibronectin (fFN) testing and transvaginal ultrasound (TVUS) cervical length (CL) measurement are used to predict sPTB in women with preterm labor (PTL).
• Evaluating the predictive accuracy and cost-effectiveness of these diagnostic tools is crucial for clinical decision-making.

Purpose of the Study:

• To assess the association between fFN testing and/or TVUS CL measurement and the prediction of sPTB.
• To evaluate the predictive value of fFN and TVUS for neonatal outcomes such as RDS and NICU admission.
• To compare the healthcare costs associated with fFN testing versus TVUS in managing PTL.

Main Methods:

• A retrospective cohort study was conducted using electronic health records from Kaiser Permanente Southern California (2009-2020).
• Pregnancies with PTL evaluations, defined by fFN and/or TVUS assessment, were identified using diagnostic codes and natural language processing.
• Multivariable logistic regression analyzed the association between fFN/TVUS results and perinatal outcomes, including sPTB, RDS, and NICU admission.

Main Results:

• Positive fFN tests were significantly associated with increased odds of sPTB (adj.OR: 2.95), RDS (adj.OR: 2.34), and NICU admission (adj.OR: 2.24).
• Negative fFN tests showed decreased odds for sPTB (adj.OR: 0.75), RDS (adj.OR: 0.67), and NICU admission (adj.OR: 0.74).
• Among positive fFN cases, sPTB odds were inversely related to CL, and fFN testing alone incurred the lowest healthcare costs.

Conclusions:

• fFN testing is a valuable predictor of sPTB, RDS, and NICU admission, with positive results indicating higher risk and negative results indicating lower risk.
• The inverse relationship between sPTB and CL in positive fFN cases highlights the importance of combined assessment.
• fFN testing demonstrates potential cost savings compared to TVUS, suggesting its utility in optimizing resource allocation for PTL management.