Authors’ reply re: Effect of QUiPP prediction algorithm on treatment decisions in women with a previous preterm birth: a prospective cohort study

Abstract

Sir, We entirely agree with Watson et al. that QUiPP provides an important contribution to the concept of individualised risk assessment and shared decisionmaking in the context of preterm birth prevention. We also agree that QUiPP, like cervical length measurements, may play a role in reassurance and targeting of interventions. However, we should also be open to a possibility that ‘false reassurance’may lead to (lack of) actions that may cause harm to individuals. We hypothesised that by applying fixed QUiPP risk thresholds, our current treatment strategies could be improved with a reduction in the false reassurance provided by long cervical length alone, so enhancing, rather than undermining, the QUiPP value. We are, therefore, pleased that peer-reviewers and Editors agreed with us that there is a merit in examining possible consequences of performing QUiPP analysis in the asymptomatic population at between 18 and 22 weeks of gestation in women with a previous preterm birth, who are often psychologically vulnerable. We completely agree with Watson et al. that the QUiPP app’s proven predictive performance ought not be dismissed, far from it. Our results should encourage other groups to publish the impact of individualised risk assessment on their clinical decisionmaking throughout pregnancy and on important clinical outcomes.& References