How are hospitals in England caring for women at risk of preterm birth in 2021? The influence of national guidance on preterm birth care in England: a national questionnaire

Abstract

Background National guidance (Saving Babies Lives Care Bundle Version 2 (SBLCBv2) Element 5) was published in 2019, with the aim to standardise preterm care in England. We plan to identify how many preterm birth surveillance clinics there are in England, and to define current national management in caring for women who are both asymptomatic and high-risk of preterm birth, and who arrive symptomatically in threatened preterm labour, to assist preterm management both nationally and internationally. Methods An online survey comprising of 27 questions was sent to all maternity units in England between February 2021 to July 2021. Results Data was obtained from 96 units. Quantitative analysis and free text analysis was then undertaken. We identified 78 preterm birth surveillance clinics in England, an increase from 30 preterm clinics in 2017. This is a staggering 160% increase in 4 years. SBLCBv2 has had a considerable impact in increasing preterm birth surveillance clinic services, with the majority (61%) of sites reporting that the NHS England publication influenced their unit in setting up their clinic. Variations exist at every step of the preterm pathway, such as deciding which risk factors warrant referral, distinguishing within particular risk factors, and offering screening tests and treatment options. Conclusions While variations in care still do persist, hospitals have done well to increase preterm surveillance clinics, under the difficult circumstances of the COVID pandemic and many without specific additional funding.

IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation (The IMPART Study)

“…Many of the practical issues relate to wider problems within the NHS, such as lack of funding and a lack of pragmatic electronic systems. Maternity risk assessment systems that lack consistency and logic can compromise clinicians’ ability in clearly communicating [ 21 ]. While it is infeasible for individual staff members to change this, they tried to make small improvements where they could.…”

“…However, rather than just having access to scans (potentially undertaken elsewhere), the IMPART study demonstrates the benefits of transvaginal cervical scanning being undertaken by clinicians within the clinic. In England 19% of hospitals highlighted a lack of clinicians able to scan and/or lack of scanning equipment as hindering preterm clinic implementation [ 21 ]. Until more qualified midwives are trained, and/or RCOG includes transvaginal scanning in their curriculum [ 53 , 54 ], this will be difficult to change.…”

“…While testing the programme theories occurred in only three case sites in England, the case sites were geographically spread, and represented a variety of maternity units, with varying preterm birth provisions serving a range of women demographically. The national questionnaire [ 21 ] utilised in developing the initial programme theories ensured a robust picture from a larger quantity of hospitals (96 units) was incorporated, before focusing on the three case sites, ensuring that the results of the IMPART study are transferrable nationwide.…”

“… Stage 1 : Formulating initial programme theories about implementation of the Preterm Birth Surveillance Pathway (using CMO hypotheses for how each programme component works) through a realist informed scope of the literature, interviews with national level programme developers and a national questionnaire of current preterm practice (published elsewhere [ 21 ]). This can be seen in Supplementary File 1 .…”

Outcomes following elective cerclage versus ultrasound surveillance in women with one prior preterm event

“…The RCOG guidance recommends that an ultrasound-indicated cerclage should be offered to women with a cervical length <25 mm if they have had one or more spontaneous preterm births (sPTB) and/or mid-trimester losses (MTL), whilst a history-indicated or elective cerclage is only recommended following three preterm events or losses [4] , [5] . However, in practice and in the age of the Montgomery test where patient informed choice is paramount, clinicians often insert elective cerclages following one preterm event [6] , [7] .…”