Effect of QUiPP prediction algorithm on treatment decisions in women with a previous preterm birth: a prospective cohort study

Abstract

Objective The QUiPP algorithm combines cervical length, quantitative fetal fibronectin (qfFN) and medical history to quantify risk of preterm birth. We assessed the utility of QUiPP to inform preterm birth prevention treatment decisions. Design A prospective cohort study with a subsequent impact assessment using the QUiPP risk of birth before 34 weeks’ gestation. Setting A UK tertiary referral hospital. Sample In all, 119 women with previous spontaneous preterm birth (sPTB) or preterm premature rupture of membranes (PPROM) before 34 weeks’ gestation. Methods Cervical length and qfFN were measured at 19+0 to 23+0 weeks’ gestation. Clinical management was based on history and cervical length. After birth, clinicians were unblinded to qfFN results and QUiPP analysis was undertaken. Main outcome measures Predictive statistics of QUiPP algorithm using 10% risk of sPTB before 34+0 weeks as treatment threshold. Results Fifteen of 119 women (13%) had PPROM or sPTB before 34 weeks. Of these, 53% (8/15) had QUiPP risk of sPTB before 34+0 weeks above 10%. Applying this treatment threshold in practice would have doubled our treatment rate (20 versus 42%). QUIPP threshold of 10% had positive likelihood ratio (LR) of 1.3 (95% CI 0.76–2.18), and negative LR of 0.8 (95% CI 0.45–1.40) for predicting sPTB before 34+0 weeks. Conclusions Use of the QUiPP algorithm in this population may lead to substantial increase in interventions without evidence that currently available treatment options are beneficial for this particular group. Tweetable abstract Independent study finds that the QUiPP algorithm could lead to substantial increases in treatment without evidence of benefit.

Cervical Assessment for Predicting Preterm Birth—Cervical Length and Beyond

“…Two studies compared and combined fFN with CL as a predictor of a PTB in asymptomatic women, and both found fFN to be a superior test [85][86][87]. However, others have demonstrated that fFN results alone are not useful [88][89][90]. In a systematic review [91] of six randomized trials in which a total of 546 women with threatened preterm labor were randomly assigned to management with reported or concealed fFN results, clinician knowledge of their fFN results did not reduce the rates of maternal hospitalization or a PTB at <34 weeks of gestation.…”

Systematic Review of Prediction Models for Preterm Birth Using CHARMS

“…Of the 16 studies that included model development, five studies collected data prospectively (Allouche et al, 2011; Gioan et al, 2018; Mercer et al, 1996; Misra et al, 2001; Zhu et al, 2017), 10 studies collected data retrospectively (Baer et al, 2018; de Caunes et al, 1990; Goyal et al, 2015; Hueston, 1998; Lee et al, 2020; Luo et al, 2016; Morken et al, 2014; Tan et al, 2007; Weber et al, 2018; Woolery, 1992), and one study combined prospective and retrospective designs (Takagi et al, 2012). Of the five studies that only conducted validation, three studies collected data prospectively (R. K. Creasy et al, 1980; Goodfellow et al, 2019; Holbrook et al, 1989), one study collected data retrospectively (Edenfield et al, 1995), and one study combined both designs (Wilson & Sill, 1973) (Table 2).…”

“…Several studies used a limited study population (Table 2). Seven studies targeted only high-risk pregnant women (e.g., short cervical length, history of PTB, or contractions) (Allouche et al, 2011; Gioan et al, 2018; Goodfellow et al, 2019; Hueston, 1998; Lee et al, 2020; Takagi et al, 2012; Woolery, 1992), and three studies were conducted in specific races (de Caunes et al, 1990; Misra et al, 2001; Weber et al, 2018). Two studies targeted only the black population (de Caunes et al, 1990; Misra et al, 2001), and one study compared non-Hispanic black and white women (Weber et al, 2018).…”

Re: Effect of QUiPP prediction algorithm on treatment decisions in women with a previous preterm birth: a prospective cohort study

“…Applying a fixed threshold to direct prophylactic interventions, as Goodfellow et al. have suggested, undermines QUiPP's value and is not the advised approach . Currently, prophylactic interventions should be directed to those with a short cervix.…”