Posted on Thursday 19 April 2018
Jo Deery with her son Cooper
A new app that can help predict if a woman is going to give birth prematurely could reduce unnecessary treatment and hospital admissions.
Around 60,000 babies are born prematurely in the UK each year, putting them at a higher risk of developing health problems.
Current guidelines advise treating all women 30 weeks pregnant and under who present symptoms of threatened preterm labour, even though many will not go on to deliver early.
Researchers from Guy’s and St Thomas’ and King's College London developed the QUiPP app to help healthcare professionals identify and treat those women who are more likely to give birth prematurely.
The app calculates the risk of premature birth using an algorithm that assesses several factors, including a history of previous premature births, a cervical length measurement (the neck of the womb) and level of fetal fibronectin (a ‘glue’ that binds the amniotic sac to the lining of the uterus).
Two previous clinical trials have shown that the app is a very accurate tool for predicting preterm birth within seven days. For example, for women experiencing symptoms, such as contractions, or women who are asymptomatic but deemed at high-risk due to other factors.
The new EQUIPTT study (Evaluation of QUiPP app for Triage and Transfer) has been launched at 13 obstetric centres across the UK – seven will use the app and six will not.
The study aims to recruit 580 women over the next 12 months to look at whether the QUiPP app can reduce the number of women with symptoms of threatened preterm labour, most of whom will not actually go on to deliver their babies within seven days, being unnecessarily admitted to hospital and given medical interventions.
Chief investigator Professor Andrew Shennan OBE, consultant obstetrician at Guy's and St Thomas' and Professor of Obstetrics at King's College London, said: “The more accurately we can predict a woman’s risk of preterm birth, the better we can manage a woman's pregnancy to ensure the safest possible birth for her and her baby.
"It can be difficult for doctors to accurately assess a woman's risk, given that many women who show symptoms of preterm labour do not go on to deliver early.”
Jo Deery, 36 from Margate in Kent, had seven miscarriages before being referred to St Thomas’ Hospital in 2015. When the mother of three fell pregnant again she had transabdominal cerclage – a stitch that closes the cervix during pregnancy to help prevent miscarriage or premature birth.
Jo, a research nurse, said: “During an antenatal appointment it was thought that the stitch wasn’t working as best as it could. As soon as I heard that I felt instant panic and dread and was sick to my stomach that I was going to lose my baby again.
“The doctors used the QUiPP app on me and it turned out that my chance of going into preterm labour again was very very small. I was able to go home and it gave me a brilliant peace of mind. I actually carried my baby son, Cooper, to full term.”
Dr Katy Kuhrt, research fellow and EQUIPTT study coordinator at Guy’s and St Thomas’, said: “To avoid missing cases, the current NICE guidelines advise that all women with symptoms of threatened preterm labour, less than 30 weeks of gestation, are treated, when in actual fact less than 3% of these women will deliver within seven days.
“Women are often admitted or transferred to other hospitals ‘just in case’ and given medication like antenatal corticosteroids. This means maternity beds and neonatal cots are blocked and unavailable for those who actually need them, which can be hugely costly to the NHS. We hope that the QUiPP app will help clinicians better manage women threatening preterm labour and move away from the traditional one size fits all approach.”
Dr Kuhrt added: “If a woman is told that she might be having her baby early and is admitted to hospital it can have a massive effect on her and her partner. Our aim is to help reduce anxiety and stress for women by making sure they are only admitted to hospital when absolutely necessary.”
Jane Brewin, Chief Executive at Tommy's Charity, said: “Targeting care to women who are at high risk of preterm birth allows precious resources to be focussed on helping those with most need whilst giving other parents at low risk, great peace of mind. This is one of those rare interventions which could give more babies the best start in life whilst saving the NHS money. The initial work looks really positive and it’s now important to check that the same results can be replicated in other hospitals.”
The EQUIPTT study and the QUiPP app both received funding from Guy’s and St Thomas’ Charity. The National Institute for Health Research, Tommy’s Charity and the King’s College London Lion’s Den Health Innovation Prize also helped fund the development of the app.