{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T02:11:14Z","timestamp":1777515074523,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2025,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n \n To validate externally the QUantitative Innovation in Predicting Preterm birth (\n QUiPP)<\/jats:styled-content>\n App v.2 for the prediction of spontaneous preterm birth (\n sPTB<\/jats:styled-content>\n ) in symptomatic women attending tertiary care in Europe.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n The\n QUiPP<\/jats:styled-content>\n App v.2 was validated in three independent datasets: a prospective European multicenter cohort across five countries (\n n<\/jats:italic>\n \u2009=\u2009452), a retrospective single\u2010center cohort in The Netherlands (\n n<\/jats:italic>\n \u2009=\u2009581) and a retrospective single\u2010center cohort in Belgium (\n n<\/jats:italic>\n \u2009=\u2009399). The cohorts consisted of pregnant women between 23 and 34\u2009weeks' gestation with symptoms of threatened preterm birth attending a tertiary care hospital between 2012 and 2023. We calculated risk estimates using the\n QUiPP<\/jats:styled-content>\n App v.2 by inputting quantitative fetal fibronectin (\n qfFN<\/jats:styled-content>\n ) and\/or cervical length (\n CL<\/jats:styled-content>\n ) measurement, in addition to other risk factors. As a result of the absence of a fibronectin detection kit in the Belgian cohort, only the\n QUiPP<\/jats:styled-content>\n model based on\n CL<\/jats:styled-content>\n could be validated in this dataset. The European cohort had no missing cases, but for the Dutch cohort, only complete cases were analyzed due to missing data. For the Belgian cohort, we statistically corrected for patients lost to follow\u2010up using inverse probability of censoring weighting. Discrimination was assessed using receiver\u2010operating\u2010characteristics (\n ROC<\/jats:styled-content>\n )\u2010curve analysis of three\n QUiPP<\/jats:styled-content>\n models (\n qfFN<\/jats:styled-content>\n alone,\n CL<\/jats:styled-content>\n alone and\n CL<\/jats:styled-content>\n plus\n qfFN<\/jats:styled-content>\n ) for the risk of\n sPTB<\/jats:styled-content>\n at six predefined timepoints: within 1, 2 and 4\u2009weeks after testing, and at <\u200930, <\u200934 and <\u200937\u2009weeks' gestation. Sensitivity, specificity and positive and negative likelihood ratios were calculated using risk thresholds of 5%, 10% and 15%. Model calibration was assessed to evaluate the agreement between expected and observed outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The predictive performance of the\n QUiPP<\/jats:styled-content>\n App v.2 for\n sPTB<\/jats:styled-content>\n within 1\u2009week after testing had an area under the\n ROC<\/jats:styled-content>\n curve (\n AUC<\/jats:styled-content>\n ) of 0.84 (95%\u2009\n CI<\/jats:styled-content>\n , 0.79\u20130.89) and 0.74 (95%\u2009\n CI,<\/jats:styled-content>\n 0.66\u20130.83) in the European and Dutch cohorts, respectively, using the combined model of CL plus qfFN, and 0.80 (95%\u2009\n CI,<\/jats:styled-content>\n 0.75\u20130.85) in the Belgian cohort using the\n CL<\/jats:styled-content>\n \u2010only model. Predictive performance was greater for shorter\u2010term outcomes, specifically\n sPTB<\/jats:styled-content>\n <\u200930\u2009weeks, compared with longer\u2010term outcomes, such as\n sPTB<\/jats:styled-content>\n <\u200937\u2009weeks. The highest\n AUC<\/jats:styled-content>\n (0.91 (95%\u2009\n CI,<\/jats:styled-content>\n 0.86\u20130.95)) was achieved by the model using\n CL<\/jats:styled-content>\n plus\n qfFN<\/jats:styled-content>\n for the prediction of\n sPTB<\/jats:styled-content>\n <\u200930\u2009weeks in the European cohort. Calibration was excellent for patients with negligible risk; however, for women at greater risk of\n sPTB<\/jats:styled-content>\n , the risk was generally underestimated compared with the observed event rate.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The\n QUiPP<\/jats:styled-content>\n App v.2 offers reassurance for patients with low predicted risk of\n sPTB<\/jats:styled-content>\n and has greater predictive performance for shorter\u2010term, compared with longer\u2010term, outcomes. Despite significant differences in prevalence from the original\n QUiPP<\/jats:styled-content>\n dataset, the model combining\n CL<\/jats:styled-content>\n plus\n qfFN<\/jats:styled-content>\n and the\n qfFN<\/jats:styled-content>\n \u2010only model perform reasonably well. Statistical correction for patients lost to follow\u2010up in the dataset comprising censored and uncensored patients improved the discriminative ability of the\n CL<\/jats:styled-content>\n predictor. \u00a9 2025 The Author(s).\n Ultrasound in Obstetrics & Gynecology<\/jats:italic>\n published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/uog.29263","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T07:38:54Z","timestamp":1750923534000},"page":"163-174","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["External validation of\n QUiPP<\/scp>\n App in three independent European cohorts of symptomatic women"],"prefix":"10.1002","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1384-9527","authenticated-orcid":false,"given":"A. M.","family":"Fischer","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam UMC location AMC Amsterdam The Netherlands"},{"name":"Amsterdam Reproduction and Development Amsterdam The Netherlands"},{"name":"Department of Computer Science Vrije Universiteit Amsterdam The\u00a0Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Bos","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam UMC location AMC Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. C. A. M.","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam UMC location AMC Amsterdam The Netherlands"},{"name":"Amsterdam Reproduction and Development Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Hoogendoorn","sequence":"additional","affiliation":[{"name":"Department of Computer Science Vrije Universiteit Amsterdam The\u00a0Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8337-550X","authenticated-orcid":false,"given":"B. W.","family":"Mol","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Monash University Melbourne Victoria Australia"},{"name":"Aberdeen Centre for Women's Health Research University of Aberdeen Aberdeen UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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