Practice Rational Testing

Tests to predict imminent delivery in threatened preterm labour

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2183 (Published 21 May 2015) Cite this as: BMJ 2015;350:h2183
  1. N L Hezelgrave, National Institute for Health Research doctoral research fellow1,
  2. A H Shennan, professor of obstetrics1,
  3. A L David, reader and consultant in obstetrics and maternal fetal medicine2
  1. 1Women’s Health Academic Centre, King’s College London, UK
  2. 2Institute for Women’s Health, UCL, London
  1. Correspondence to: A L David a.david{at}ucl.ac.uk

The bottom line

  • Most women presenting with symptoms of threatened preterm labour give birth at term

  • Predictive bedside tests such as quantitative fetal fibronectin, PAM-G1 (placental α microglobulin 1), and phIGFBP-1 (phosphorylated insulin-like growth factor binding protein 1) can risk stratify symptomatic women. “Low or negative” results can provide reassurance to most women and may avoid inappropriate interventions

  • Women with “high or positive” test results who do not deliver in the short term may be at increased risk of preterm birth at a later gestation and should be followed up by an experienced obstetrician

How patients were involved in the creation of this article

This article was reviewed by Susan Harper-Clarke, a member of the St Thomas’ Hospital/King’s College London Premature Birth Patient, Carer, Public Involvement and Engagement (PCPIE) group. She suggested that healthcare professionals should consider patient anxiety associated with unnecessary interventions in the absence of predictive testing.

A 30 year old gravida 2 para 0 woman presented to her local hospital at 25 weeks’ gestation with a four hour history of worsening “contraction-like” abdominal pain every 5-10 minutes. She had had a miscarriage at 23 weeks’ after similar symptoms a year earlier; no cause had been identified. Mild uterine tightenings were confirmed on abdominal palpation. She had no fever or symptoms of urinary tract infection and the fetal heart rate was normal. A vaginal speculum examination showed a long closed cervix with normal vaginal discharge. No neonatal cots were available in the event of delivery.

What is the next investigation?

Because of her symptoms and history of late miscarriage, this woman should be considered at high risk of spontaneous preterm birth. However, regardless of history, women who present with symptoms and signs of threatened preterm labour rarely deliver early; most (75%) deliver at term.1 Even women with one previous spontaneous preterm birth or late miscarriage have only a 15% chance of spontaneous preterm birth in …

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