{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:33:29Z","timestamp":1740126809482,"version":"3.37.3"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:p>\n            Objective\u2003Fetal fibronectin (fFN) testing and transvaginal ultrasound (TVUS) are diagnostic tools used to predict impending spontaneous preterm birth (sPTB) among women presenting with preterm labor (PTL). We evaluated the association between fFN testing or TVUS cervical length (CL) measurement in predicting sPTB, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) admission, and sPTB-related costs.<\/jats:p><jats:p>\n            Study Design\u2003We conducted a retrospective cohort study using data from the Kaiser Permanente Southern California electronic health system (January 1, 2009\u2013December 31, 2020) using diagnostic and procedure codes, along with a natural language processing algorithm to identify pregnancies with PTL evaluations. PTL evaluation was defined as having fFN and\/or TVUS assessment. Outcomes were ascertained using diagnostic, procedural, and diagnosis-related group codes. Multivariable logistic regression assessed the association between fFN and\/or TVUS results and perinatal outcomes.<\/jats:p><jats:p>\n            Results\u2003Compared with those without PTL evaluations, those with positive fFN tests had higher adjusted odds ratio (adj.OR) for sPTB (2.95, 95% confidence interval [CI]: 2.64, 3.29), RDS (2.34, 95% CI: 2.03, 2.69), and NICU admission (2.24, 95% CI: 2.01, 2.50). In contrast, those who tested negative had lower odds for sPTB (adj.OR: 0.75, 95% CI: 0.70, 0.79), RDS (adj.OR: 0.67, 95% CI: 0.61, 0.73), and NICU admission (adj.OR: 0.74, 95% CI: 0.70, 0.79). Among those with positive fFN results, the odds of sPTB was inversely associated with CL. Health care costs for mothers and neonates were lowest for those with fFN testing only.<\/jats:p><jats:p>\n            Conclusion\u2003This study demonstrates that positive fFN results were associated with an increased odds of sPTB, RDS, and NICU admission and the association with sPTB was inversely proportional to CL. Additionally, negative fFN results were associated with decreased odds of sPTB, RDS, and NICU admissions. fFN testing may predict these and other sPTB-related adverse outcomes hence its utility should be explored further. Moreover, fFN testing has some cost savings over TVUS.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0044-1786545","type":"journal-article","created":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T22:58:22Z","timestamp":1715122702000},"page":"2214-2221","source":"Crossref","is-referenced-by-count":0,"title":["Management, Utilization, and Outcomes of Preterm Labor in an Integrated Health Care System"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3610-8841","authenticated-orcid":false,"given":"Darios","family":"Getahun","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Sacks","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaxiao","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1565-0490","authenticated-orcid":false,"given":"Fagen","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nehaa","family":"Khadka","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicki Y.","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nana A.","family":"Mensah","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chantal C.","family":"Avila","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meiyu","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aniket A.","family":"Kawatkar","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Ruma","sequence":"additional","affiliation":[{"name":"Perinatal Associates of New Mexico, Maternal-Fetal Medicine, Albuquerque, New Mexico"},{"name":"Hologic Inc., Diagnostics, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Joyce","sequence":"additional","affiliation":[{"name":"Hologic Inc., Diagnostics, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Fassett","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California"},{"name":"Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,5,7]]},"reference":[{"key":"ref2","first-page":"1","article-title":"Births: Final Data for 2014. 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