Predictive performance of PAMG‐1 vs fFN test for risk of spontaneous preterm birth in symptomatic women attending an emergency obstetric unit: retrospective cohort study

Abstract

To assess the performance of the PAMG-1 and fFN tests using real-world data for the prediction of spontaneous preterm delivery (sPTD) in patients presenting to an emergency obstetrical unit with threatened preterm labour (PTL) by conducting a retrospective audit of patient medical records over two different one-year time periods during which either fFN or PAMG-1 was used as the standard of care biochemical test. A retrospective cohort study chart review of women with threatened PTL electronic medical records (EMR) from a Level III maternity hospital was conducted for two periods of one year each: (1) the “Baseline” time period, during which the qualitative fFN test with a cutoff of 50 ng/ml was used as standard of care biochemical test for the risk assessment of preterm delivery, and (2) the “Comparative” time period, during which the PAMG-1 test with a cutoff of 1 ng/mL was used as the standard of care biomarker test. Patients with singleton gestations between 24⁺⁰ to 34⁺⁶ weeks of gestation with symptoms of early preterm labour, clinically intact membranes, and cervical dilation 4 times more reliable than a positive fFN test in predicting imminent sPTD. Fewer positive biomarker test results that are more reliable is associated with a reduction in unnecessary admissions, avoidable treatments, and preventable use of hospital resources.