The influence of the introduction of national guidelines on preterm birth prevention practice: UK experience

Abstract

Objective To identify the current status of specialist preterm labour ( PTL ) clinics and identify changes in management trends over the last 5 years following release of the NICE preterm birth ( PTB ) guidance. Design Postal Survey of Clinical Practice. Setting UK . Population All consultant‐led obstetric units. Methods A questionnaire was sent by post to all 187 NHS consultant‐led obstetric units. Units with a specialist PTL clinic were asked to answer a further six questions defining their protocol for risk stratification and management. Main outcome measures Current practice in specialist PTL clinics. Changes in treatment trends over 5 years. Results Thirty‐three PTL prevention clinics were identified, with 73% running weekly. NHS staff (84%) have replaced university staff as the lead clinicians (from 69% in 2012 to 21% in 2017), suggesting this clinic has become increasingly integrated with standard care for women at the highest risk of PTB . There has been a large shift from nearly half of clinics offering cerclage as primary treatment for short cervix to offering more choice (30%) between at least two of cerclage, vaginal progesterone or pessary and combinations of primary treatments (18%), demonstrating more equipoise among clinicians regarding therapies for short cervix. Conclusions Over 5 years, there has been a 44% increase in the number of specialist PTL clinics in the UK . Although there is a better consensus over the target high‐risk population, there is increasing heterogeneity among first‐line treatments for short cervix. Tweetable abstract UK PTB prevention clinics have increased by 44% over 5 years, with increasing clinical equipoise to best Rx for short cervix.

Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth

“…We observed variations in first-line treatment choice for vignette 1 regarding cervical cerclage, vaginal progesterone, and tocolysis. These results are consistent with those of Care et al, 29 who recently conducted a questionnaire study in the UK 5 years after the publication of National Institute for Health and Care Excellence (NICE) guidelines about preterm birth. They found divergence in the primary treatments used for short cervix.…”

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

“…The majority of studies included UK based preterm birth clinics, and some reported on multiple clinics. To ensure we avoided over-representation of clinics described in more than one study, authors of UK studies that reported on unnamed clinics were approached [23][24][25][26]. This allowed us to assess whether the largest and most comprehensive study on preterm birth clinics (Care 2019) [23] included all UK clinics described in other studies.…”

“…To ensure we avoided over-representation of clinics described in more than one study, authors of UK studies that reported on unnamed clinics were approached [23][24][25][26]. This allowed us to assess whether the largest and most comprehensive study on preterm birth clinics (Care 2019) [23] included all UK clinics described in other studies. All but four clinics in the Care 2019 study were identified and alternative studies including them were excluded from synthesis [25][26][27][28][29][30][31][32][33][34][35].…”

“…Three of these were conference abstracts for included full text articles [37][38][39]. One study had been updated and the two publications were combined [23,40]. A further eight were additional studies reporting on individual clinics already represented by another included study [41][42][43][44][45][46][47][48] (detailed in Table 1).…”

“…Of the 20 included studies, 15 were full text articles [23, 24, 27-29, 33, 34, 49-56] and five were conference abstracts [26,[30][31][32]36]. 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].…”