Journal de la grossesse et de la santé infantile

Abstrait

Triaging Hospitalization in Threatened Preterm Labor Patients Using a Biochemical Marker and Transvaginal Ultrasound-A Pilot Implementation Study in a Tertiary Center of North India

Meenoo S, Reva Tripathi, Shakun Tyagi, Siddarth Ramji, Sarita Shah and YM Mala

Background: Hospitalization rates for threatened or arrested preterm labour pains are high but often unnecessary. The main aim of this study was to determine the need for hospitalization in patients with threatened Preterm Labor (PTL) after testing for the presence of Phosphorylated Insulin like Growth Factor Binding Protein-1 (phIGFBP-1) in cervicovaginal secretions followed by cervical length assessment.
Methods: A prospective study was conducted in a cohort of one hundred patients of threatened PTL. They were evaluated for presence of phIGFBP-1 in cervicovaginal secretions using a bedside kit followed by cervical length measurement by Transvaginal Sonography (TVS). If either phIGFBP-1 test was positive and/or cervical length was less than or equal to 25 mm, the patient was admitted and hospital protocol was followed. If phIGFBP-1 was negative and cervical length was more than 25 mm, then the patient was counselled for home management. All patients were followed till delivery.
Result: Implementation of these tests resulted in hospitalization rate of 16% in patients with threatened PTL which was a reduction by 80% and was statistically significant with p value of <0.001. No patient assigned to home management (n=84) delivered either within 48 h or 7 days of testing. Nine patients (10.7%) delivered between one to four weeks whereas the remaining 75 patients (89.2%) delivered after four weeks. Approximate cost savings varied from INR 1,62,000 to INR 1,536,570 ($2323 to $22030) for 100 patients.
Conclusion: The use of these tests will decrease burden of hospitalization amongst patients thereby resulting in minimising unnecessary treatment and medical expenses.