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Compliance with Fetal Fibronectin Testing at a Canadian Tertiary Care Perinatal Centre

Published:August 03, 2020DOI:https://doi.org/10.1016/j.jogc.2020.06.028

      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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