[Economical impact of preterm delivery management based on fetal fibronectin results].
BACKGROUND
Preterm labor continues to be the first cause (after congenital malformations) of morbidity and mortality during the perinatal period. One of the markers showing the highest sensitivity to predict preterm labor seems to be fetal fibronectin (fFN) determined in the cervicovaginal secretion.


OBJECTIVE
To identify patients at risk of preterm labor based on the presence of fFN in cervicovaginal secretions and to analyze the cost-benefit of medical attention and hospital stay depending on the fFN results.


METHODS
Four hundred and sixty two patients were admitted in a 6 month period to the Maternal-Fetal Medicine Department. All of them had symptoms of preterm labor. Their gestational ages were between 24 and 34 weeks, the fFN analyses were taken from cervical vaginal secretion. One hundred and fifty eight were fFN positive and 304 were negative. Patients with positive fFN were hospitalized and received specific treatment for preterm labor. The patients with negative fFN were sent home with no medical treatment. In order to calculate the economic impact of the hospital's medical attention we considered the total cost in pesos which included patient's hospital care when admitted with preterm labor symptoms, hospital stay, and neonatal attention. The total costs were compared and analyzed in the two groups.


RESULTS
The average cost generated for fFN positive and negative patients was 23,059 and 7,859 pesos, respectively. Approximately 15,200 pesos were saved per patient in this group. Multiplying this amount among patients with negative fFN (n=304), we would have saved 4,620,000 pesos in a 6 month period. Our established medical management did not affect negatively maternal-fetal well being. For statistical purposes of variables the Mann Whitney U, chi square and McNemar's tests were calculated.


CONCLUSIONS
By determining fFN for the diagnosis of preterm labor, we obtained savings of 4,620,000 pesos in a 6 month period avoiding unnecessary treatments and hospital stay in patients with negative fFN. Determination of fFN in cervical vaginal secretion in patients with symptoms of preterm labor showed to have high sensitivity and specificity in predicting preterm labor between 24-34 weeks of gestation, permitting a more rational use of medical management and resources and avoiding unnecessary treatments. The treatment instituted on the basis of an opportune diagnosis in patients with positive fFN showed to prolong weeks of gestation. Although a persistence of morbidity and mortality of prematurity has been reported, these have diminished in comparison with studies previously done in the institution.
García Alonso
L Angel
LA
Departamento de medicina perinatal y unidad de investigación medica en medicina reproductiva, Hospital de Ginecología y Obstetricia Luis Castelazo Ayala, IMSS. angelalo@prodigy.net.mx
Ayala Méndez
José Antonio
JA
Jiménez Solís
Guillermo
G
Aguilar Gutiérrez
Fabiola
F
Díaz Cueto
Laura
L
D001826:Body Fluids / Q000737:chemistry; D002584:Cervix Uteri; D003362:Cost-Benefit Analysis; D005260:Female; D005353:Fibronectins / Q000032:analysis*; D006023:Glycoproteins / Q000032:analysis*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000191:economics*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
C403421:FFN protein, human; D005353:Fibronectins; D006023:Glycoproteins