Blood test to predict premature birth welcomed with caution
According to the article in Science, studies show the test as 80 per cent accurate in both areas. Using bloods tests instead of an ultrasound scan to date the pregnancy has been hailed as an opportunity to reduce the cost of dating pregnancies and improve accuracy, particularly where resources are limited and ultrasounds are not freely available.
The Royal College of Obstetricians and Gynaecologists issued a statement urging caution, however, because of the small sample size of women involved in the study and highlighted that wider testing is needed to assure accuracy. That said, a blood test is relatively non-invasive and so long as women are appropriately consented, it seems an easy trial to roll out across a broad cohort of women so hopefully a larger trial will follow. Allowing women to more accurately date their pregnancies without having to go through repeated scans is clearly beneficial.
These developments are important tools in creating safer management of pregnancy to avoid adverse outcomes, such as we see when there are unanticipated premature births, where appropriate care is not in place to deal with the health consequences of prematurity.
Currently, if a woman is considered to be at risk of premature birth, various treatments and methods of assessment are available. If a woman goes into hospital complaining of abdominal pain, for example, and there is suspicion she might be in premature labour, Dawes-Redman CTGs can be run which are very accurate in identifying whether a woman is in labour.
The limitation of that test, however, is that while it is accurate in identifying if a woman is in labour at the point that the CTGs are run, it is not as good a predictor of whether in two hours or two days she will go into spontaneous labour, nor how fast that labour might be.
In a tragic case, my client was assessed using Dawes-Redman CTG on several occasions and each time was deemed not to be in labour and was sent home. When she was finally admitted overnight for additional observations, although she was not thought to be in labour, she went into spontaneous labour that progressed rapidly and she suffered a uterine rupture causing significant injury to her and to her child. This new blood test may be used to assess the likelihood of premature delivery and, if effective, it could be a useful management tool in a situation such as my client was in. Knowledge of due dates allows better planning for the delivery, neonatal care and ensuring the appropriate protocols are applied and clinical pathways.
However, many of the problems in cases where premature labour and delivery result in injuries to mothers and babies lie not with being unable to predict when the baby is due, rather being unable to manage an emergency situation when labour does start, or making clinical decisions as to when to actively intervene during labour or how to manage the neonate once born. Unless there is focus on improving management of labour, birth injury cases caused by substandard management of labour will unfortunately continue.