Increasing compliance with a clinical practice guideline for fetal fibronectin testing and the management of threatened preterm labour: A quality improvement project

Eur J Obstet Gynecol Reprod Biol. 2018 Feb;221:89-96. doi: 10.1016/j.ejogrb.2017.12.017. Epub 2017 Dec 16.


Objective: To increase adherence to a local hospital clinical practice guideline for the use of fetal fibronectin testing in women presenting with symptoms of threatened preterm labour.

Study design: A quality improvement project using a multi-faceted implementation strategy.

Setting: National Women's Health, Auckland City Hospital; a tertiary referral maternity unit in Auckland, New Zealand.

Population: All obstetricians, junior obstetric doctors and hospital employed midwives.

Methods: A pre-education audit and survey, compulsory interactive educational intervention with audit feedback and provision of reminders followed by a post-education audit and survey one year later.

Main outcome measures: Number of fetal fibronectin tests performed, proportion of tests performed meeting clinical criteria for testing and proportion of results managed according to hospital guideline.

Results: There was a 25% increase in the number of tests performed with an increase in the proportion that met clinical criteria for testing, 76% (31/41)-93% (51/55) (OR 4.1, 95% CI 1.2-14.2). Adherence to guidelines for clinical management according to fFN results changed over time, 80% (33/41)-95% (52/55) (OR 4.2, 95% CI 1.04-17.0). Clinician knowledge on some (but not all) indications for fFN testing improved. Education and reminders did not improve understanding of clinical scenarios that may result in a false positive fFN test.

Conclusions: A multi-faceted approach of audit and clinician feedback, interactive education and reminders supports the implementation of a clinical practice guideline for the use of fFN as a preterm birth prediction test for women presenting with symptoms of threatened preterm labour.

Keywords: Audit; Clinical practice guidelines; Education; Fetal fibronectin; Implementation; Preterm birth.

MeSH terms

  • Biomarkers / blood
  • Female
  • Fibronectins / blood*
  • Guideline Adherence*
  • Humans
  • Obstetric Labor, Premature / diagnosis
  • Obstetric Labor, Premature / therapy*
  • Practice Guidelines as Topic*
  • Pregnancy
  • Quality Improvement*


  • Biomarkers
  • Fibronectins