PPO.13 Does specialist antenatal care for women at risk of preterm birth affect patient selection, rate and outcomes of cervical cerclage?

Burul, G; James, CP; Forya, F; Casagrandi, D.; Tetteh, A.; Al-Fahdi, Badriya Sulaiman; Fox, Gary N.; Warner, D. Michael; Kenyon, A; David, AL

doi:10.1136/archdischild-2014-306576.453

Cited by 2 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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]. Of the four clinics reported anonymously in the Care 2019 study, three are also believed to have been reported elsewhere and so these studies were also excluded [24,36].…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…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].…”

Section: Study Characteristicsmentioning

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%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Synthesis Of Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“… 4. Burul et al [ 29 ], retrospective-cohort, clinic cases from January 2005 to December 2008, London-UK (abstract). 210 cerclage cases: 85 cases before the establish of the clinic and 125 afterwards Cervical cerclage 1.…”

Section: Resultsmentioning

confidence: 99%

“…The three most recent UK studies were published only as abstracts [ 28 – 30 ] and involved a retrospective case-note analysis of patients registered at the clinics. In Burul [ 29 ] the focus of the study was to collect data on cervical cerclage and pregnancy outcomes. A total 210 cerclage cases were identified at the PTB clinic, 85 cases before the PTB clinic was established (January 2005–December 2012) and 120 cases since January 2005–December 2012.…”

Section: Resultsmentioning

confidence: 99%

Specialist antenatal clinics for women at high risk of preterm birth: a systematic review of qualitative and quantitative research

Malouf

Redshaw

2017

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

BackgroundPreterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Women with previous prenatal loss are at higher risk of preterm birth. A specialist antenatal clinic is considered as one approach to improve maternity and pregnancy outcomes.MethodsA systematic review of quantitative, qualitative and mixed method studies conducted on women at high risk of preterm birth (PTB). The review primary outcomes were to report on the specialist antenatal clinics effect in preventing or reducing preterm birth, perinatal mortality and morbidity and women’s perceptions and experiences of a specialist clinic whether compared or not compared with standard antenatal care. Other secondary maternal, infant and economic outcomes were also determined. A comprehensive search strategy was carried out in English within electronic databases as far back as 1980. The reviewers selected studies, assessed the quality, and extracted data independently. Results were summarized and tabulated.ResultsEleven studies fully met the review inclusion criteria, ten were quantitative design studies and only one was a qualitative design study. No mixed method design study was included in the review. All were published after 1989, seven were conducted in the USA and four in the UK. Results from five good to low quality randomised controlled trials (RCTs), all conducted before 1990, did not illustrate the efficacy of the clinic in reducing preterm birth. Whereas results from more recent low quality cohort studies showed some positive neonatal outcomes. Themes from one good quality qualitative study reflected on the emotional and psychological need to reduce anxiety and stress of women referred to such a clinic. Women expressed their negative emotional responses at being labelled as high risk and positive responses to being assessed and treated in the clinic. Women also reported that their partners were struggling to cope emotionally.ConclusionsFindings from this review were mixed. Evidence from cohort studies indicated a specialist clinic may be a means of predicting or preventing preterm birth. Testing this in a randomised controlled trial is desirable, though may be hard to achieve due to the growing focus of such clinics on managing women at high risk of preterm birth. Ongoing research has to recognize women’s experiences and perceptions of such a clinic. Further clarification of the optimal referral route and a clear and standardized management and cost economic evaluation plan are also required. Fathers support and experience of PTB clinics should also be included in further research.

show abstract

PPO.13 Does specialist antenatal care for women at risk of preterm birth affect patient selection, rate and outcomes of cervical cerclage?

Cited by 2 publications

References 0 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

Specialist antenatal clinics for women at high risk of preterm birth: a systematic review of qualitative and quantitative research

Contact Info

Product

Resources

About