Pilot study into the efficacy of foetal fibronectin testing in minimising hospital admissions in women presenting with symptoms of preterm labour: a randomised controlled trial of obstetric and neonatal outcomes.

AIMS: The purpose of this pilot study was to determine the role of foetal fibronectin (fFN) testing in women presenting to hospital with symptoms of preterm labour in reducing the hospital admissions, without significantly increasing the risk of preterm birth and neonatal respiratory distress syndrome. METHODS: Women with symptoms of preterm labour were assigned randomly to receive fFN (n = 44) or to preterm labour management without fFN (n = 44). In the testing arm, the result of the test was revealed to the clinician. Clinical outcomes were compared in the two groups. The time period covered by the randomised controlled trial (RCT) was from December 2007 to March 2009. The RCT was conducted in two large maternity units in the west of Scotland, one in Glasgow the other in Ayrshire. RESULTS: All the women with fibronectin positive got admitted while only 32.4% of the fibronectin negatives were admitted (P = 0.002). There was a significant difference in the mean length of stay between the fibronectin positives which was 47.17 h, and the negatives which was 12.9 h (P = 0.018). Overall the control and testing arms did not differ in respect to admissions and length of stay. 5 out of 7 positives and 11 out of 37 negatives had corticosteroids (P = 0.089). 2 out of 7 positives and 1 out of 37 negatives had tocolytics (P = 0.073). CONCLUSIONS: Those who had the fFN test done were less likely to be admitted in the hospital and had a shorter length of stay, without any increase in the adverse maternal or foetal effects, avoiding unnecessary admissions.

Unusual underlying cause of recurrent vulval abscess.

An ex-intravenous drug user was admitted four times during a 2 year period from December 2006, with the same complaint of vulval abscess which required repeat incision and drainage procedures. In January 2009, a pelvic x-ray showed widening of the symphysis pubis, marginal irregularities, and severe erosive changes which were consistent with pubic osteomyelitis. She was treated with intravenous ciprofloxacin and clindamycin for 2 weeks and was discharged on oral antibiotics for 6 weeks. She recovered well and her condition has significantly improved with no recurrent infection so far. She is now being followed up every 4-6 weeks at the orthopaedics outpatient clinic.