Details of HTA project
Last updated: 15 July 2008 - Next update due: 22 July 2008
Research type: |
Secondary Research (e.g. systematic review) |
Project title: |
Screening to prevent pre-term birth - systematic reviews of accuracy and effectiveness literature with economic modelling |
Project ref: |
05/03/01 |
Cost: |
£213,494 |
Chief Investigator : |
Professor Khalid Khan, Professor of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, University of Birmingham |
Start Date: |
October 2005. |
Publication date: |
November 2008. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
Premature birth occurs in one in ten pregnancies. It is a serious condition and is associated with a significant risk of disease and death in the newborn baby. It is associated with substantial use of healthcare resources. Clinical decisions about when to start effective treatment to prevent premature birth require timely and accurate diagnosis of pre-term labour pains. But, at present, there is considerable variation in screening and testing strategies to predict the onset of pre-term labour pains. There is conflicting evidence as to how to effectively look after such patients and further research is needed in this field. We intend to address the issues identified in the HTA commissioning brief (05/03) on 'Screening to prevent pre-term birth' by: 1. Examining all of the research available to find out how accurate various available tests are at identifying pregnant women in early pregnancy who may be at risk of giving birth prematurely. 2. Investigating how effective various treatments and medications are at stopping premature labour. 3. Exploring the cost effectiveness of these test and treatments or medications for women at risk of delivering their babies early. From these, we will look at what further research is needed (and what recommendations can be made to improve practice). |
Abstract: |
Pre-term birth, i.e. delivery at less than 37 completed weeks' of gestation, is a heterogeneous condition. About 40% of all cases of pre-term birth are due to elective delivery for a maternal or a fetal complication where it is judged that the baby is better delivered in the mother's interest or that of its own. Spontaneous pre-term birth any prior to 37 weeks' gestation occurs in 7-11% of pregnancies and occurs in 3-7% of pregnancies before 34 weeks' gestation. Pre-term delivery, particularly that before 34 weeks' gestation, accounts for three-quarters of neonatal mortality and one-half of long term neurological impairment in children. Many of the surviving infants suffer serious morbidity such as respiratory distress syndrome, broncho-pulmonary dysplasia, intraventricular haemorrhage, retrolental fibroplasia and developmental problems. Advances in perinatal healthcare have not reduced the rate of pre-term birth, but there are some effective interventions to reduce the risk of short and long term sequelae to the premature neonates. Prediction of pregnant women's risk for pre-term birth both for screening or diagnosis, based on a combination of patients' characteristics, symptoms, physical signs and investigations, is important. This is because without accurate tests clinicians are handicapped in the management of pregnant women at risk of pre-term birth. For example, the decision regarding the institution of antenatal interventions requires timely and accurate screening and diagnosis of pregnant for the risk of pre-term birth. Wrong or delayed diagnosis can put mother and baby at risk of an adverse outcome whereas the correct prediction of pre-term birth provides an opportunity to institute effective therapeutic interventions. Obstetricians routinely incorporate many test results into decision-making concerning management of women at risk of pre-term birth, but studies to examine the ways in which even a small number of these tests alter the benefit and harm of treatments are rare. Our research will follow the key steps involved in diagnostic health technology assessment and will meet the following objectives: 1. To determine, among asymptomatic women in early pregnancy, (a) the accuracy of various tests (history, examination and investigations) for predicting the risk pre-term birth, and (b) the effectiveness of preventative interventions for women identified to be at high risk of pre-term birth through testing in early pregnancy, 2. To determine, among women in late (viable) pregnancy symptomatic of threatened pre-term labour, (a) the accuracy of various tests (history, examination and investigations) for predicting the risk of imminent pre-term birth, and (b) the effectiveness of preventative interventions for women identified to be at high risk of pre-term birth through testing at the time of presentation. 3. To determine the cost-effectiveness of testing (including test combinations) and consequent prevention and treatment strategies in terms of both human and financial costs using decision-analytic modelling. |
MeSH* index primary terms: |
INFANT-PREMATURE; INFANT-PREMATURE-DISEASES Q-prevention-&-control; INFANT-MORTALITY |
MeSH* index secondary terms: |
HUMANS; FEMALE; PREGNANCY; DECISION-MAKING; RISK-FACTORS; COST-BENEFIT-ANALYSIS; REVIEW |
NRR* number, if applicable: |
N0484171029 (*National Research Register) |
Project Protocol: |
Project protocol not available |
URL of this page: |
http://www.hta.ac.uk/1486 |
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