Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes

Whitworth, Melissa; Quenby, Siobhán

doi:10.1002/14651858.cd006760

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…This systematic review aims to assess the referral criteria and investigations and interventions offered in preterm birth clinics internationally and the planned timing and frequency of review. It does not attempt to prove the efficacy of preterm clinics as it has already been established that there is currently inadequate evidence available [11,12]. The results of this systematic review will be useful for future work in improving consistency in care in both established and new preterm birth clinics.…”

Section: Rationalementioning

confidence: 99%

“…Although there is good evidence to support many of the practices that occur in preterm birth clinics, specific evidence to support the utility of preterm birth clinics as a whole is still evolving [5]. Two previous systematic reviews have attempted to assess the efficacy of preterm birth clinics in reducing spontaneous preterm birth and improving neonatal outcomes [11,12]. Neither found conclusive evidence to either support or refute the efficacy of specialised preterm birth clinics compared to standard antenatal care [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Two previous systematic reviews have attempted to assess the efficacy of preterm birth clinics in reducing spontaneous preterm birth and improving neonatal outcomes [11,12]. Neither found conclusive evidence to either support or refute the efficacy of specialised preterm birth clinics compared to standard antenatal care [11,12]. However, both acknowledged the limited number of studies in this field; only five were randomised controlled trials, all of which were conducted prior to 1990 and no longer reflect practice in modern-day preterm birth clinics.…”

Section: Introductionmentioning

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: Rationalementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…To date, systematic reviews have demonstrated only limited evidence that PTBCs reduce sPTB rates; however, these reviews included historic studies not reflective of current care 6,7 . The benefits of coordinated and individualised care, increasing evidence to support interventions, and the ongoing poor outcomes as a consequence of PTB, provide rationale for these clinics 5,7 .…”

Section: Introductionmentioning

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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“…7 The complications of impaired placentation are significant contributors to maternal and perinatal morbidity and mortality in developing countries. 8,9,10 Therefore it is justified to recommend Doppler velocimetry of the uterine artery in developing countries because of the high prevalence of mortality and morbidity due to complications of impaired placentation. Umbilical artery Doppler also carries a prognostic value in predicting the outcomes of growth restricted fetuses.…”

Section: Introductionmentioning

confidence: 99%

The Role of Obstetric Doppler Velocimetry Studies In Predicting Mode of Delivery and Perinatal Outcome

Sangolkar¹

2016

jmscr

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Background: The antenatal fetal surveillance aims at detecting any evidence of fetal jeopardy at the earliest. The practice of routine late third trimester obstetric ultrasound with Doppler Velocimetry has been shown to improve detection of fetal growth restriction at an early stage when prompt measures can be taken. Ultrasonography with Doppler Velocimetry has become a useful tool in antenatal surveillance because of its safety, non-invasiveness and reliability in antenatal fetal surveillance. This study was done to analyze the role of Obstetric Doppler Velocimetry studies in predicting mode of delivery and perinatal outcome. Methods: The study was carried out in 112 pregnant females attending the antenatal clinic at

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Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes

Abstract: Background-Amongst the risk factors for preterm birth, previous preterm delivery is a strong predictor. Specialised clinics for women with a history of spontaneous preterm delivery have been advocated as a way of improving outcomes for women and their infants.

Cited by 4 publications

References 18 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

The Role of Obstetric Doppler Velocimetry Studies In Predicting Mode of Delivery and Perinatal Outcome

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