The QUiPP App: a safe alternative to a treat‐all strategy for threatened preterm labor

Watson, Helena; Carter, Jenny; Seed, Paul; Tribe, Rachel M.; Shennan, Andrew

doi:10.1002/uog.17499

Cited by 55 publications

(49 citation statements)

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“…In the first part, a prospective cohort study, data was collected for the development of a risk assessment tool for calculating individual likelihood of preterm birth. The tool combines background risk factors, gestation and test results (fetal fibronectin and cervical length) and calculates a simple percentage risk of delivery within certain clinically important time points (Watson et al, 2017). Knowledge of this individualised risk may enhance clinical decision making and increase confidence that management is offered to those most at risk while reducing unnecessary intervention and providing reassurance to those who are not.…”

Section: Aimsmentioning

confidence: 99%

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study

et al. 2018

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Section: Aimsmentioning

confidence: 99%

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study

et al. 2018

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“…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%

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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“…In this cohort, nine times fewer women would have received intervention compared with the NICE treat‐all strategy. All true cases were correctly identified …”

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confidence: 94%

“…New evidence confirming the expediency of ACS benefit, and utilisation of predictive tools (e.g. QUiPP app) should ultimately decrease unnecessary and potentially harmful steroid practices.…”

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confidence: 99%

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Re: Antenatal corticosteroids: it's all about timing

Ridout

Watson

Best³

et al. 2017

BJOG

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study was a particular design of longitudinal panel study in which the unit of analysis was followed up at specified intervals over a long period. The key feature of this panel study is that we collected repeated measures from the same sample (pregnant women who received transendometrial myomectomy during the first caesarean delivery reporting a subsequent live pregnancy and planning an elective repeat caesarean delivery) at different points in time. We would expect little change in the genotypes of HPV, Mycobacterium tubercle, and Chlamydia for the same population over a short period of time. Also, we did not analyse medical, psychiatric, and life-style factors, obstetric history, or ethnicity characteristic for the same population in this study.However, we did have the preoperative and postoperative colour Doppler imaging data, and postoperative hysteroscopic imaging for the 328 women who had myomectomy at the first operation, and for the 63 women at the subsequent operation. These data showed no major discernible anatomical changes from the novel transendometrial myomectomy procedure during pregnancy. Additionally, in our unpublished cross-sectional study derived from this report, the surgical outcomes of two types of myomectomy procedures (the traditional transserosal myomectomy and transendometrial myomectomy) during caesarean delivery revealed that this novel transendometrial approach was related to less uterine deformity, minimal adhesion, and minimised adverse operative outcome or serious complications such as bowel obstruction, or even impaired fertility after caesarean myomectomy based on the imaging analysis.

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The QUiPP App: a safe alternative to a treat‐all strategy for threatened preterm labor

Abstract: ABSTRACT

Cited by 55 publications

References 13 publications

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study

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

Re: Antenatal corticosteroids: it's all about timing

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