Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For patients in preterm labor, what is the comparative effectiveness of the most common treatments? Which treatments prevent the labor the longest with the fewest side effects?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Bed rest, terbutaline, Procardia, cerclage, and magnesium sulfate.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Pregnant women, generally healthy, who begin active labor before week 36 of the pregnancy. It would probably be useful to look at women under 18, 18-35, and 35 and above to see if there are any differences. Also, diabetics may very well have different responses.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

The goal is for babies to be born no earlier than 36 weeks of gestational age, but also to avoid some of the unpleasant side effects of the treatments. Keeping pregnant women healthier while also keeping the babies healthier would be the best outcome.

Describe any health-related risks, side effects, or harms that you are concerned about.

I don't know if drugs like terbutaline or magnesium sulfate affect the fetus, but presumably someone has studied that. A risk-benefit analysis of the various treatments would be very useful to pregnant women facing preterm labor.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Pregnancy, including preterm birth

AHRQ Priority Populations

• Women

Federal Health Care Program

None

Importance

Describe why this topic is important.

It is a very common condition and premature babies are extremely expensive. It seems as though a safe way to treat the problem would be beneficial.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I went into preterm labor with both of my children and each time I was given a treatment, I would ask why. Invariably the answer was a shrug and "It seems to work for some women."

None of the doctors I dealt with could tell me why a treatment worked or how often it worked or who it worked for.

Fortunately, both of my children survived, but they both spent weeks in a NICU. I hope that in the future other women can avoid this.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

As I said above, clinicians seemed to have no idea which treatments would work and which wouldn't. They simply threw a random group of treatments at me and hoped one of them would stick.

This isn't ideal when it comes to pregnant women!

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

I'm actually an AHRQ subcontractor, editing Comparative Effectiveness Reviews and I thought it would be nice to see this addressed.