ABSTRACT
Objective
The purpose of this study was to assess compliance with fetal fibronectin (fFN) testing
recommendations at a single tertiary care perinatal centre. The secondary objective
was to identify factors associated with compliance with these recommendations.
Methods
A retrospective cohort study was conducted from January 1, 2016 to December 31, 2016
of all patients who presented to the IWK Health Centre with suspected preterm labour.
Inclusion criteria included symptoms of preterm labour prior to 370 weeks gestation, singleton or multiple pregnancy, and established fetal wellbeing.
Exclusion criteria included severe fetal anomaly, contraindications to tocolysis,
transfer from community hospital, or inadequate documentation. Provider compliance
was evaluated to determine: 1) whether the test was performed for appropriate indications
according to provincial fFN guidelines; 2) whether fFN results were appropriately
being used to inform patient care. Logistic regression was used to determine factors
associated with compliance.
Results
A total of 528 patients presented with symptoms of preterm labour. The overall compliance
with testing recommendations was 76.1%. Compliance for patients who met criteria for
fFN testing was 73%, and compliance for those not meeting criteria was 76.4%. Of patients
with a negative fFN result, 85.3% were appropriately discharged home without intervention.
Gestational age, time of day, and non-obstetrician provider type were found to be
associated with compliance.
Conclusion
Despite regional and national guidelines, this study demonstrates a compliance rate
of 76% in our centre, indicating a gap in provider knowledge regarding proper use
and interpretation of fFN. Non-obstetrician provider type was associated with decreased
compliance.
RÉSUMÉ
Objectif
L'objectif de cette étude était d’évaluer la conformité aux recommandations en matière
de détection de la fibronectine fœtale (FNf) dans un seul centre de soins périnataux
tertiaires. L'objectif secondaire était de déterminer les facteurs associés à la conformité
aux recommandations.
Méthodologie
Une étude de cohorte rétrospective a été menée du 1er janvier au 31 décembre 2016 chez toutes les patientes manifestant un travail avant
terme présumé à l'IWK Health Centre. Les critères d'inclusion étaient la présence
de symptômes de travail avant terme à moins de 37 SA + 0 j; une grossesse monofœtale,
gémellaire ou multiple; et un bien-être fœtal établi. Les critères d'exclusion étaient
les anomalies fœtales graves, les contre-indications à la tocolyse, le transfert en
provenance d'un hôpital communautaire ou un dossier médical inadéquat. La conformité
du fournisseur de soins a été évaluée afin de déterminer : 1) si le test de détection
a été effectué pour des indications appropriées conformément aux lignes directrices
provinciales relativement à la FNf ; 2) si les résultats de détection de la FNf étaient
adéquatement utilisés pour orienter la prestation de soins. Une régression logistique
a été utilisée pour déterminer les facteurs associés à la conformité.
Résultats
Au total, 528 patientes présentaient des symptômes de travail avant terme. La conformité
globale aux recommandations en matière de détection de la FNf était de 76,1 %. La
conformité aux recommandations était de 73 % pour les patientes répondant aux critères
de détection de la FNf et de 76,4 % pour celles qui n'y répondaient pas. Parmi les
patientes ayant obtenu un résultat de détection de la FNf négatif, 85,3 % ont reçu
un congé adéquat sans intervention. L’âge gestationnel, l'heure de la journée et le
type de fournisseur de soins non-obstétricien ont été associés à la conformité.
Conclusion
Malgré les lignes directrices régionales et nationales, cette étude révèle un taux
de conformité de 76 % dans notre centre, ce qui indique une lacune dans les connaissances
des fournisseurs de soins en ce qui concerne l'utilisation et l'interprétation appropriées
de la détection de la FNf. Le type de fournisseur de soins non-obstétricien était
associé à une diminution de la conformité.
Keywords
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Article info
Publication history
Published online: August 03, 2020
Footnotes
Disclosures: This research was supported by an H. B. Atlee Foundation endowment grant.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
