An app could help doctors predict risk of preterm birth

QUiPP

Across the globe, 15 million babies are born preterm (before 37 weeks) each year and over a million of these die of prematurity-related complications. There are a number of factors that are used to determine if a woman is at risk of giving birth prematurely, including a history of preterm births or late miscarriages. Two additional factors are the length of cervix and levels of a biomarker found in vaginal fluid known as fetal fibronectin.

King’s College London has developed an app, called QUiPP, to tackle this problem to help doctors better identify women at risk of giving birth prematurely. The application uses an algorithm that combines the gestation of previous pregnancies and the length of the cervix with levels of fetal fibronectin to classify a woman’s risk. And it was already tested in two studies of high-risk women being monitored at ante-natal clinics.

In the first study, published in the journal Ultrasound in Obstetrics & Gynecology, researchers collected data from 1,249 women at high risk for pre-term birth attending surveillance clinics. The model was developed on the first 624 consecutive women and validated on the subsequent 625. The estimated probability of delivery before 30, 34 or 37 weeks’ gestation and within two or four weeks of testing for fetal fibronectin was calculated for each patient and analyzed as a predictive test for the actual occurrence of each event.

In the second study, researchers were looking to predict the likelihood of early delivery in a group of women showing symptoms of early labor which often doesn’t progress to real labor. Also published in the journal Ultrasound in Obstetrics & Gynecology, the study collected data from 382 women — the model was developed on the first 190 and validated on the remaining 192 women.

In two studies, QUiPP was found to perform far better than each component taken alone.In both studies, QUiPP was found to perform far better than each component (previous pregnancy, cervical length or fetal fibronectin) taken alone. The conclusion was that the app can be used by clinicians to improve the estimation of the probability of premature delivery and to potentially tailor clinical management decisions.

However, further work is needed to clinically evaluate it in practice, and to ascertain whether interventions improve the pregnancy outcome for women identified as high risk by the app.

“Despite advances in prenatal care the rate of preterm birth has never been higher in recent years, including in the US and UK, so doctors need reliable ways of predicting whether a woman is at risk of giving birth early,” Professor Andrew Shennan, lead author who is Professor of Obstetrics at King’s College London and consultant obstetrician at Guy’s and St Thomas’ NHS Foundation Trust, said in a statement. “It can be difficult to accurately assess a woman’s risk, given that many women who show symptoms of preterm labor do not go on to deliver early.”

QUiPP is available as a free download from the Apple App Store.