Introduction 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. Methodology 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 outcome. Results 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. Conclusion 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.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:341303 |
| Date | January 2001 |
| Creators | Mohanna, Magdi |
| Publisher | Keele University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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