Threatened Preterm Labor : Cost of Hospital Admissions Interview with: Robert E. Garfield, PhD

Department of Perinatology, Division of Obstetrics and Gynecology
University Medical Centre Ljubljana, Slovenia

Costs of Unnecessary Admissions and Treatments for “Threatened Preterm Labor” :What are the main findings of the study?

Dr. Garfield: Unnecessary admissions and treatments for “threatened preterm labor” are still part of everyday clinical practice and contribute to exploding healthcare costs. This happens despite substantial evidence that measuring CL by trans-vaginal ultrasound can help to avoid needless interventions due to the high negative predictive values of this test.

Were any of the findings unexpected?

Dr. Garfield: The U.S. spends more per capita on publicly funded health care than just about every other developed country, including spending more than those countries with universal publicly funded health care systems. The high expenses associated with admissions and treatments were, therefore, expected. What was surprising, however, was how much unnecessary tests, admissions, and treatments, not supported by evidence, contribute to the economic burden of preterm labor hospitalizations.

What should clinicians and patients take away from your report?

Dr. Garfield: The potential of reducing costs in everyday clinical practice without jeopardizing outcome is enormous. There is no question that health care costs must be reduced, and clinicians have a major responsibility in this regard. But if providers are not willing to embrace evidence-based medicine to reduce costs, then someone else will find a different way to reduce them. And in that case, physicians will no longer be the ones deciding how their patients are treated.

What recommendations do you have for future research as a result of this study?

Dr. Garfield: While it is clear that TOCO has low positive predictive value for preterm labor, and that CL and FFN test have high negative predictive utility, there is as yet no test for early preterm labor that has a high positive predictive value. Uterine electromyography (EMG), as studied in our center, may prove to be such a test (Lucovnik M, Maner WL, Chambliss LR, et al. Noninvasive uterine electromyography for prediction of preterm delivery. Am J Obstet Gynecol 2011;204:228.e1-10.). Studies that compare the specificity, sensitivity, and predictive value of EMG to TOCO, CL, and fetal fibronectin should be performed in women who present with signs and symptoms of preterm labor.


Costs of Unnecessary Admissions and Treatments for “Threatened Preterm Labor”

Lucovnik M, Chambliss LR, Garfield RE.

Department of Obstetrics and Gynecology, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, United States, 85013; Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Slovenia.

Am J Obstet Gynecol. 2013 Jun 28. pii: S0002-9378(13)00708-4. doi: 10.1016/j.ajog.2013.06.046. [Epub ahead of print]