Does fetal fibronectin use in the diagnosis of preterm labor affect physician behavior and health care costs? A randomized trial

Objective The purpose of this study was to determine whether a knowledge of fetal fibronectin results affects patient treatment and health care costs. Study design Women between 24 and 34 weeks of gestation with a singleton pregnancy and preterm uterine contractions were eligible for enrollment. Once informed consent was given, a fetal fibronectin specimen was obtained, and women were assigned randomly into 2 groups. In 1 group, results of the fetal fibronectin test were available; in the other group, results were not available. The use of inpatient and outpatient health care resources subsequent to enrollment was ascertained through the use of medical records, hospital billing data, and patient interviews. This study was powered to allow the detection in the fetal fibronectin group of a 20% reduction in total health care-related costs. Results The 2 groups were similar with respect to maternal age, parity, race, cervical examination at admission, and estimated gestational age at enrollment and at delivery. Women who did not have fetal fibronectin results available were no different than those women who did with respect to initial length of labor and delivery observation (median, 4 hours vs 3 hours), hospital admission (28% vs 26%), tocolysis (18% vs 16%), cessation of work (27% vs 26%), or total health care-related costs (log mean ± SD, 7.6 ± 1.2 vs 7.5 ± 1.1). Conclusion In this study population, the use of fetal fibronectin did not affect physician behavior or health care costs related to preterm contractions.