Assessment of the impact of introducing fetal fibronectin assay in the management of preterm labour at Middlemore Hospital, New Zealand.
Elevated levels of fetal fibronectin (fFN) in cervicovaginal secretions beyond 20-22 weeks of gestation are used as a predictor of preterm birth in patients with corroborative symptoms and signs.


OBJECTIVE
To assess the impact of introducing the fFN assay on the diagnosis, length of hospital stay and cost of managing patients presenting with symptoms of premature labour in our hospital.


METHODS
The first 30 fFN-tested patients (fFN group) were prospectively recruited and followed up until delivery. Hospital stay and management costs (costs of individual tests and treatment administered) and neonatal outcomes were compared with 30 matching historical controls.


RESULTS
Overall management costs of the fFN-group were comparable with controls (NZ dollar 918 versus NZ dollar 943 per patient, p = 0.44). The fFN-group had a trend towards reduced length of hospital stay (p = 0.082), less tocolysis (p = 0.002) and use of steroids (p < 0.001). The cost of managing an fFN-positive patient was more than an fFN-negative patient, but not statistically significant (NZ dollar 1117 versus NZ dollar 846, respectively, p = 0.11).


CONCLUSIONS
Despite a trend towards reduced hospital stay and less use of obstetric intervention, total expenditure in patient management has not reduced with the availability of the fFN assay in our hospital. This may only reflect the slow introduction of a new policy that with time may be implemented to full effect.
Musaad
Samarina M A
SM
Biochemistry Department, Middlemore Hospital, Auckland, New Zealand. SamarinaM@adhb.govt.nz
Melson
C Louise
CL
Boswell
D Ross
DR
D000328:Adult; D005260:Female; D005353:Fibronectins / Q000032:analysis*; D006023:Glycoproteins / Q000032:analysis*; D006801:Humans; D007163:Immunosorbent Techniques / Q000191:economics; D007902:Length of Stay; D009520:New Zealand; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000191:economics*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D014621:Vagina / Q000378:metabolism
C403421:FFN protein, human; D005353:Fibronectins; D006023:Glycoproteins