Preterm birth : evaluation of an intervention programme comprising risk factor scoring, fetal fibronectin testing and nifedipine tocolysis.
Neonatal mortality and morbidity from premature birth are still a major concern despite significant
advances in perinatal medicine.
Objective of the study
The primary aim of the study was to establish the feasibility of accurately identifying a cohort of
vvomen at increased risk of preterm birth using a modified risk assessment score and fetal fibronectin
testing in order to undertake a pilot randomised placebo-controlled trial of nifedipine as a tocolytic.
A population of pregnant women was screened prospectively between 24 and 34 weeks of gestation
using a modified risk assessment system. Women identified as high-risk for preterm birth were then
tested with fetal fibronectin. Those testing positive were randomised to either nifedipine or placebo.
The study at this point was randomised, placebo-controlled and double-blind. Measures of outcome
were compared for babies of trial vvomen with high-risk women who withheld consent.
Main outcome measures
Delivery before 34 weeks, neonatal death, admission to the Special Care Baby Unit (SCBU), chronic
lung disease and major cerebral abnormality on ultrasound scan constituted the main measures of
Five hundred and thirty four vvomen were identified as high-risk for preterm birth. One hundred and
forty two women agreed to participate in the study. Forty nine women delivered before 37 weeks'
gestation. The system was sensitive in predicting preterm birth before 34 weeks of gestation and
within one week of testing for fetal fibronectin in symptomatic women. Babies of non-consenting
mothers fared better overall than babies of the trial women.
Risk factor scoring and fetal fibronectin testing are useful screening tools that can predict preterm
delivery. This sysytem can be clinically useful in the management of preterm labour or women at
increased risk for preterm birth. There was no impact on the neonatal mortality or morbidity.