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Am J Perinatol 2024; 41(16): 2214-2221
DOI: 10.1055/s-0044-1786545
Original Article

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

Darios Getahun 
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
2   Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
David A. Sacks
3   Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, California
,
Jiaxiao Shi
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Fagen Xie 
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Nehaa Khadka
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Vicki Y. Chiu
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Nana A. Mensah
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Chantal C. Avila
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Meiyu Yeh
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Aniket A. Kawatkar
1   Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Michael S. Ruma
4   Perinatal Associates of New Mexico, Maternal-Fetal Medicine, Albuquerque, New Mexico
5   Hologic Inc., Diagnostics, San Diego, California
,
Derek Joyce
5   Hologic Inc., Diagnostics, San Diego, California
,
Michael J. Fassett
6   Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
7   Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
› Author Affiliations Funding This study was supported by Hologic Inc.
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Abstract

Objective Fetal fibronectin (fFN) testing and transvaginal ultrasound (TVUS) are diagnostic tools used to predict impending spontaneous preterm birth (sPTB) among women presenting with preterm labor (PTL). We evaluated the association between fFN testing or TVUS cervical length (CL) measurement in predicting sPTB, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) admission, and sPTB-related costs.

Study Design We conducted a retrospective cohort study using data from the Kaiser Permanente Southern California electronic health system (January 1, 2009–December 31, 2020) using diagnostic and procedure codes, along with a natural language processing algorithm to identify pregnancies with PTL evaluations. PTL evaluation was defined as having fFN and/or TVUS assessment. Outcomes were ascertained using diagnostic, procedural, and diagnosis-related group codes. Multivariable logistic regression assessed the association between fFN and/or TVUS results and perinatal outcomes.

Results Compared with those without PTL evaluations, those with positive fFN tests had higher adjusted odds ratio (adj.OR) for sPTB (2.95, 95% confidence interval [CI]: 2.64, 3.29), RDS (2.34, 95% CI: 2.03, 2.69), and NICU admission (2.24, 95% CI: 2.01, 2.50). In contrast, those who tested negative had lower odds for sPTB (adj.OR: 0.75, 95% CI: 0.70, 0.79), RDS (adj.OR: 0.67, 95% CI: 0.61, 0.73), and NICU admission (adj.OR: 0.74, 95% CI: 0.70, 0.79). Among those with positive fFN results, the odds of sPTB was inversely associated with CL. Health care costs for mothers and neonates were lowest for those with fFN testing only.

Conclusion This study demonstrates that positive fFN results were associated with an increased odds of sPTB, RDS, and NICU admission and the association with sPTB was inversely proportional to CL. Additionally, negative fFN results were associated with decreased odds of sPTB, RDS, and NICU admissions. fFN testing may predict these and other sPTB-related adverse outcomes hence its utility should be explored further. Moreover, fFN testing has some cost savings over TVUS.

Key Points

  • Patients with positive fFN tests had higher odds of sPTB, RDS, and NICU admission.

  • Inverse relationship between sPTB and CL among those with positive fFN tests was observed.

  • Health care costs for mothers and neonates were lowest for those with fFN testing only.

Keywords

preterm labor - fetal fibronectin - transvaginal ultrasound - preterm birth - respiratory distress syndrome - neonatal intensive care - natural language processing


Publication History

Received: 31 January 2024

Accepted: 24 March 2024

Article published online:
07 May 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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