QUiPP v2 Preterm Birth Risk

A clinical decision tool to revolutionize preterm birth prediction for symptomatic and high-risk asymptomatic women.

Target: Spontaneous Preterm Birth (sPTB) Risk Settings: Triage & Surveillance Clinics Reference: quipp.org Version: v2

What it evaluates

Calculates an individualized percentage (%) risk of spontaneous preterm birth (sPTB) within specific timeframes.

The algorithm combines maternal risk factors (like prior sPTB) with quantitative fetal fibronectin (qfFN) and transvaginal cervical length (CL) measurements.

Clinical Settings

The app is designed for use in two specific clinical settings:

  • Asymptomatic high-risk women: For management and surveillance of women with known risk factors (e.g., prior sPTB, previous cervical surgery).
  • Symptomatic women: For triaging women presenting with symptoms of threatened preterm labour (e.g., contractions, abdominal pain).

Required Inputs

  • Relevant clinical history: Prior sPTB or PPROM, late miscarriage, or previous cervical surgery.
  • Current symptoms: Presence of abnormal or premature uterine activity.
  • Quantitative Fetal Fibronectin (qfFN): From a cervico-vaginal fluid sample.
  • Transvaginal Cervical Length (CL): Standardized ultrasound measurement (in mm).

Output and Interpretation

The app provides a simple, individualized percentage risk score for delivery within clinically relevant timeframes (e.g., within 7 days, 14 days, or before 34 weeks).

  • This score helps clinicians tailor management decisions and support shared decision-making with patients.
  • A common threshold studied for triage is a 5% risk of delivery within 7 days.

Benefits and Practical Integration

  • Targeted Interventions: Helps ensure women who need interventions (e.g., corticosteroids, admission, in-utero transfer) receive them appropriately.
  • Reduce Over-Management: Safely reassures low-risk women, preventing unnecessary hospital admissions and treatments.
  • Shared Decisions: Designed to be used *with* the patient as an educational tool to explain risk and management options.

Evidence and Validation

  • Developed by researchers at King’s College London, supported by Guy’s and St Thomas’ Charity, NIHR, and Tommy’s.
  • Symptomatic (Triage): The Watson et al. study (2017) found that using a 5% risk threshold had 100% sensitivity and 100% NPV for delivery within 7 days, potentially avoiding 89.4% of admissions compared to a 'treat-all' policy.
  • Asymptomatic (Surveillance): The Carter et al. study (2020) validated the v2 algorithm for high-risk asymptomatic women, showing high predictive accuracy (ROC areas 0.77–0.99).

Version and Sources

Version: v2 — QUiPP app models from King’s College London.

Key references and sources:

  1. Carter J, Watson HA, Shennan AH, Tribe RM. QUiPP v.2: Development and validation of a novel algorithm to predict spontaneous preterm birth in asymptomatic high-risk women. Ultrasound Obstet Gynecol. 2020.
  2. Watson HA, Carter J, Seed PT, Tribe RM, Shennan AH. The QUiPP App: a safe alternative to a treat-all strategy for threatened preterm labour. Ultrasound Obstet Gynecol. 2017.
  3. Official website: quipp.org (app access and implementation notes).

Disclaimer

This application is intended for use by healthcare professionals with significant midwifery or obstetric experience. The tool supports clinical decision-making and does not replace local guidelines or clinical judgment.