Costs of unnecessary admissions and treatments for “threatened preterm labor”

Uterine Cervical Length Measurement to Reduce Length of Stay in Patients Admitted for Threatened Preterm Labor: A Randomized Trial

“…The study was designed in the late nineties, well before the extended use of CL in clinical practice. However, although the information obtained in this study may seem to be outdated, there are few studies on women hospitalized because of threatened preterm labor [5,17,18,25,26]. Moreover, recent studies using CL in patients admitted because of threatened preterm labor have shown that the mean CL at admission is comparable with ours and that up to 70-85% of patients admitted will finally deliver at term [4,5,9,13,14].…”

“…In addition, there is some evidence on its role as a discriminating factor in women with symptoms of preterm labor [12][13][14][15][16], which may allow proper risk assessment to avoid overdiagnosis and overtreatment. Nonetheless, recent studies on women admitted because of threatened preterm labor reported a CL mean (standard deviation [SD]) of 30.9 (10.2) mm [13] and a rate of admitted patients with CL >30 mm of 36% [5], which is higher than expected considering the application of published cutoff values. This may be due to admissions to units where CL is not evaluated because of lack of facilities or trained personnel before admission, added risk factors (mild bleeding, distance from home, maternal disease, …) or individual patient characteristics (e.g., previous history of preterm birth), or because of the persistence of symptoms regardless of CL measurement.…”

“…Even though a 1-day reduction might not seem that relevant, in nonresearch conditions the impact of this approach could be greater as other studies have described a much longer length of stay compared to ours [18,20,25,26]. In fact, a recent descriptive study by Lucovnik et al [5] demonstrated that unnecessary admissions and treatments related to threatened preterm birth significantly contribute to healthcare costs.…”

“…However, although the information obtained in this study may seem to be outdated, there are few studies on women hospitalized because of threatened preterm labor [5,17,18,25,26]. Moreover, recent studies using CL in patients admitted because of threatened preterm labor have shown that the mean CL at admission is comparable with ours and that up to 70-85% of patients admitted will finally deliver at term [4,5,9,13,14]. In addition, some studies have reported that the accuracy of CL for the prediction of preterm delivery in symptomatic women might be limited [13,14], leading some clinicians to favor admission in the presence of other risk factors or persistence of symptoms despite CL being >25 mm.…”

Prescribing patterns of antenatal corticosteroids in women with threatened preterm labor

“…The combination of fFN testing and CL measurement may reduce unnecessary costs [41][42][43][44]. A recent model-based costeffectiveness analysis conducted in the Netherlands, found that treating only women presenting with PTL and a CL < 10 mm or a CL between 10 and 30 mm with a positive fFN test, is cost saving without compromising neonatal health outcomes [43] ACS administration could initially be omitted in women with a CL between 10 and 30 mm and a negative fFN test and in women with a CL > 30 mm.…”