García Alonso L Angel, Ayala Méndez José Antonio, Jiménez Solís Guillermo, Aguilar Gutiérrez Fabiola, Díaz Cueto Laura
Departamento de medicina perinatal y unidad de investigación medica en medicina reproductiva, Hospital de Ginecología y Obstetricia Luis Castelazo Ayala, IMSS.
Ginecol Obstet Mex. 2004 Aug;72:385-93.
Preterm labor continues to be the first cause (after congenital malformations) of morbidity and mortality during the perinatal period. One of the markers showing the highest sensitivity to predict preterm labor seems to be fetal fibronectin (fFN) determined in the cervicovaginal secretion.
To identify patients at risk of preterm labor based on the presence of fFN in cervicovaginal secretions and to analyze the cost-benefit of medical attention and hospital stay depending on the fFN results.
Four hundred and sixty two patients were admitted in a 6 month period to the Maternal-Fetal Medicine Department. All of them had symptoms of preterm labor. Their gestational ages were between 24 and 34 weeks, the fFN analyses were taken from cervical vaginal secretion. One hundred and fifty eight were fFN positive and 304 were negative. Patients with positive fFN were hospitalized and received specific treatment for preterm labor. The patients with negative fFN were sent home with no medical treatment. In order to calculate the economic impact of the hospital's medical attention we considered the total cost in pesos which included patient's hospital care when admitted with preterm labor symptoms, hospital stay, and neonatal attention. The total costs were compared and analyzed in the two groups.
The average cost generated for fFN positive and negative patients was 23,059 and 7,859 pesos, respectively. Approximately 15,200 pesos were saved per patient in this group. Multiplying this amount among patients with negative fFN (n=304), we would have saved 4,620,000 pesos in a 6 month period. Our established medical management did not affect negatively maternal-fetal well being. For statistical purposes of variables the Mann Whitney U, chi square and McNemar's tests were calculated.
By determining fFN for the diagnosis of preterm labor, we obtained savings of 4,620,000 pesos in a 6 month period avoiding unnecessary treatments and hospital stay in patients with negative fFN. Determination of fFN in cervical vaginal secretion in patients with symptoms of preterm labor showed to have high sensitivity and specificity in predicting preterm labor between 24-34 weeks of gestation, permitting a more rational use of medical management and resources and avoiding unnecessary treatments. The treatment instituted on the basis of an opportune diagnosis in patients with positive fFN showed to prolong weeks of gestation. Although a persistence of morbidity and mortality of prematurity has been reported, these have diminished in comparison with studies previously done in the institution.
早产仍然是围产期发病率和死亡率的首要原因（仅次于先天性畸形）。对预测早产敏感性最高的标志物之一似乎是宫颈阴道分泌物中检测到的胎儿纤维连接蛋白（fFN）。
根据宫颈阴道分泌物中fFN的存在情况识别早产风险患者，并根据fFN结果分析医疗护理和住院的成本效益。
在6个月期间，462例患者入住母胎医学科。他们均有早产症状。孕周在24至34周之间，fFN分析取自宫颈阴道分泌物。158例fFN阳性，304例阴性。fFN阳性患者住院并接受早产的特定治疗。fFN阴性患者回家且未接受治疗。为了计算医院医疗护理的经济影响，我们考虑了以比索计算的总成本，其中包括有早产症状入院时患者的医院护理、住院时间和新生儿护理。对两组的总成本进行比较和分析。
fFN阳性和阴性患者产生的平均成本分别为23,059比索和7,859比索。该组每位患者节省了约15,200比索。将此金额乘以fFN阴性患者（n = 304），在6个月期间我们将节省4,620,000比索。我们既定的医疗管理对母胎健康没有负面影响。为进行变量的统计学分析，计算了曼-惠特尼U检验、卡方检验和麦克内马尔检验。
通过检测fFN诊断早产，我们在6个月期间节省了4,620,000比索，避免了fFN阴性患者的不必要治疗和住院。对有早产症状患者的宫颈阴道分泌物进行fFN检测，在预测妊娠24 - 34周早产方面显示出高敏感性和特异性，从而能更合理地利用医疗管理和资源并避免不必要的治疗。基于对fFN阳性患者的及时诊断所采取的治疗显示可延长孕周。尽管有报道称早产的发病率和死亡率持续存在，但与该机构先前的研究相比已有所降低。
