Outcomes and predictive tests from a dedicated specialist clinic for women at high risk of preterm labour: A ten year audit

Hughes, Kathryn Clare; Sim, Shirlene; Roman, Alina; Michalak, Kasia; Kane, Stefan C.; Sheehan, Penelope M.

doi:10.1111/ajo.12610

Cited by 14 publications

(18 citation statements)

References 31 publications

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“…Data from 39 clinics were combined to assess the primary and secondary outcomes; 33 UK based clinics from Care 2019 23 and six clinics from individual clinic studies outside of the UK [7,[49][50][51][52][53]. Outcome data was incomplete for some clinics, thus the number of clinics assessed for each outcome varies.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…Fourteen studies reported on an individual clinic [27-33, 36, 49-53, 56] and six studies reported on multiple clinics [23,24,26,34,54,55]. There were a variety of study designs; seven retrospective audits [26,[28][29][30][31][32]51], three prospective observational studies [24,36,55], two cross-sectional studies [23,49], two prospective cohort studies [54,56], two retrospective cohort studies [50,52], two other retrospective observational studies [27,34], one randomised controlled trial [53], and one qualitative interpretive study [33]. A total of 39 clinics were assessed in data synthesis; 33 clinics (87%) were in the UK, two in America, two in Australia, and one each in Germany and Italy.…”

Section: Study Characteristicsmentioning

confidence: 99%

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The use of specialised preterm birth clinics for women at high risk of spontaneous preterm birth: a systematic review

Dawes

Groom

Jordan

et al. 2020

BMC Pregnancy Childbirth

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Background: Specialised preterm birth clinics care for women at high risk of spontaneous preterm birth. This systematic review assesses current practice within preterm birth clinics globally. Methods: A comprehensive search strategy was used to identify all studies on preterm birth clinics on the MEDLINE, Embase, PsycINFO, CENTRAL and CINAHL databases. There were no restrictions to study design. Studies were limited to the English language and publications from 1998 onwards. Two reviewers assessed studies for inclusion, performed data extraction and reviewed methodological quality. Primary outcomes were referral criteria, investigations and interventions offered in preterm birth clinics. Secondary outcomes were the timing of planned first and last appointments and frequency of review. Results: Thirty-two records fulfilled eligibility criteria and 20 studies were included in the main analysis following grouping of records describing the same study or clinic. Studies were of mixed study design and methodological quality. A total of 39 clinics were described; outcome data was not available for all clinics. Referral criteria included previous spontaneous preterm birth (38/38, 100%), previous mid-trimester loss (34/38, 89%) and previous cervical surgery (33/38, 87%). All clinics offered transvaginal cervical length scans. Additional investigations varied, including urogenital swabs (16/28, 57%) and fetal fibronectin (8/28, 29%). The primary treatment of choice for a sonographic short cervix was cervical cerclage in 10/33 (30%) clinics and vaginal progesterone in 6/33 (18%), with 10/33 (30%) using multiple first-line options and 6/33 (18%) using a combination of treatments. The majority of clinics planned timing of first review for 12-16 weeks (30/35, 86%) and the frequency of review was usually determined by clinical findings (18/24, 75%). There was a wide variation in gestational age at clinic discharge between 24 and 37 weeks.Conclusions: There is variation in the referral criteria, investigations and interventions offered in preterm birth clinics and in the timing and frequency of review. Consistency in practice may improve with the introduction of consensus guidelines and national preterm birth prevention programmes.Trial registration: Systematic review registration number: CRD42019131470.

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Section: Synthesis Of Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

The use of specialised preterm birth clinics for women at high risk of spontaneous preterm birth: a systematic review

Dawes

Groom

Jordan

et al. 2020

BMC Pregnancy Childbirth

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“…A recent systematic review has assessed practice in PTBCs globally 17 and identified only two studies that reported outcomes from PTBCs in Australasia 18,19 . Hughes and colleagues have described their ten‐year PTBC experience in Melbourne 19 .…”

Section: Discussionmentioning

confidence: 99%

The experience and outcomes of a specialised preterm birth clinic in New Zealand

Dawes

Restall

Sousa

et al. 2020

Aust NZ J Obst Gynaeco

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Background: A greater understanding of the risk factors for spontaneous preterm birth and the importance of risk stratification to guide interventions has led to the introduction of preterm birth prevention clinics. Aim: To evaluate the experience and outcomes of the first specialised preterm birth clinic in New Zealand. Materials and methods: This observational study reviewed pregnancies cared for in a preterm birth clinic from 2013 to 2018. Cases were identified and data collected from a maternity database and electronic medical records. Analysis was by referral type. Results: A total of 423 cases were included; 309 elective and 22 acute referrals in pregnancy, and 92 consultations outside pregnancy. For those referred electively in pregnancy, 138/309 (44.7%) fulfilled multiple referral criteria, and 57/309 (18.4%) had ≥2 previous spontaneous preterm births or second trimester losses. Excluding five pregnancies with first trimester miscarriage, 77/304 (25.3%) were managed with a history-indicated cerclage (11 placed pre-conception) and 217/304 (71.4%) had cervical surveillance as primary management, of which 133 (61.3%) did not require treatment. The remaining had treatment for a short cervix; 37 (17.0%) received an ultrasound-indicated cerclage only, 21 (9.7%) vaginal progesterone only and 26 (12.0%) both. Five women (1.6%) had a second trimester loss at 13 +0-19 +6 and 58/297 (19.5%) had a spontaneous preterm birth at 20 +0-36 +6 weeks. The 'take home baby' rate was 95.4%. Conclusions: Pregnancy outcomes were similar to those reported by other preterm birth prevention clinics. The majority of women who received cervical surveillance as primary management were able to avoid additional treatment.

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“…TVUS cervical length measurement technique has been described previously. 13 Exclusion criteria comprised medically indicated preterm birth, missing delivery data or conflicting/unclear documentation of uterine anomaly. Women with an arcuate uterus were not referred to the Preterm labor Clinic due to conflicting reports about the impact of the arcuate uterus on reproductive outcomes.…”

Section: Participantsmentioning

confidence: 99%

Cervical length surveillance for predicting spontaneous preterm birth in women with uterine anomalies: A cohort study

Hughes

Kane

Haines

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: Uterine anomalies occur in an estimated 5% of women and have been shown to confer a higher risk of spontaneous preterm birth (SPTB). A sonographically short cervix (<25 mm) is a risk indicator for SPTB, although its predictive utility has been little studied in this specific high-risk population. We aimed to assess the pregnancy outcomes and predictive ability of short cervix in a cohort of women with uterine anomalies attending a high-risk antenatal clinic.

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Outcomes and predictive tests from a dedicated specialist clinic for women at high risk of preterm labour: A ten year audit

Abstract: The adjusted preterm birth rate at the Royal Women's Hospital's Preterm Labour Clinic has decreased significantly over the decade studied. Positive fetal fibronectin at 26 weeks and elevated serum alkaline phosphatase are independent predictors of preterm birth.

Cited by 14 publications

References 31 publications

The use of specialised preterm birth clinics for women at high risk of spontaneous preterm birth: a systematic review

The use of specialised preterm birth clinics for women at high risk of spontaneous preterm birth: a systematic review

The experience and outcomes of a specialised preterm birth clinic in New Zealand

Cervical length surveillance for predicting spontaneous preterm birth in women with uterine anomalies: A cohort study

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