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

Carter, Jenny; Tribe, Rachel M.; Shennan, Andrew; Sandall, Jane

doi:10.1016/j.midw.2018.06.001

Cited by 29 publications

(28 citation statements)

References 35 publications

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“…There is very limited evidence on the lived experience of women who are at risk of preterm labour or birth1 so the findings from this study are important to consider for future practice, however the small sample size may limit how the findings could be applied to practice. Consistent advice received by high-risk women may well have been due to the well-established preterm birth surveillance clinic and the confidence of the clinicians in their care pathways.…”

Section: Commentarymentioning

confidence: 97%

“…A significant issue for the women in the study revolves around continuity of carer, and this is something that has been acknowledged in several key documents published by the Department of Health and NHS England 4–6. Carter et al 1 recognised that continuity of carer could be achieved through the establishment of national guidelines with the recommendation of a referral service to a specialist surveillance team. Many maternity units in the UK do not have these specialist services in place; however, if they were, they may result in consistency of advice and targeted interventions that would reduce preterm birth and the risks associated with it.…”

Section: Commentarymentioning

confidence: 99%

“…Many maternity units in the UK do not have these specialist services in place; however, if they were, they may result in consistency of advice and targeted interventions that would reduce preterm birth and the risks associated with it. The study1 also recognised that the utilisation of reliable tests such as cervical length measurement and/or fetal fibronectin could reduce the feelings of stress and anxiety experienced by women considered to be at low risk of preterm delivery. It could also reduce the number of hospital admissions and unnecessary interventions.…”

Section: Commentarymentioning

confidence: 99%

“…Carter et al 1 also recognised that the responses of the women who were high risk may have been influenced by their previous experience.…”

Section: Commentarymentioning

confidence: 99%

See 3 more Smart Citations

Women who experience threatened preterm labour need early and accurate assessment, a clear management plan and continuity of care to reduce stress and anxiety

Gordon

2019

Evid Based Nurs

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Section: Commentarymentioning

confidence: 97%

Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

“…Carter et al 1 also recognised that the responses of the women who were high risk may have been influenced by their previous experience.…”

Section: Commentarymentioning

confidence: 99%

See 2 more Smart Citations

Women who experience threatened preterm labour need early and accurate assessment, a clear management plan and continuity of care to reduce stress and anxiety

Gordon

2019

Evid Based Nurs

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“…Threatened premature labor (TPTL) is a sign of giving birth in the middle and late stages of pregnancy before normal delivery (<37 weeks). It is reported that 65% of pregnant women with TPTL will give birth prematurely (before 37 weeks) (1), while ~30% of hospitalized patients related to pregnancy are due to TPTL (2), and premature labor is still the leading cause of neonatal death and attack (3,4). Some studies have shown that ~30% of premature labor is the result of spontaneous premature labor, and only ~10-15% of women with symptoms of premature labor will give birth within the next 2-7 days (5).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of allylestrenol combined with ritodrine on threatened premature labor and its influence on inflammatory factors in peripheral blood

Jin

2019

Exp Ther Med

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Efficacy of allylestrenol combined with ritodrine on threatened premature labor (TPTL) and its influence on inflammatory factors in peripheral blood were investigated. A total of 206 cases of TPTL patients from 2014 to 2016 were collected in Zhongshan Hospital Affiliated to Fudan University, and 106 cases were treated with allylestrenol combined with ritodrine as a research group and 100 cases were treated with allylestrenol combined with magnesium sulfate as a control group. General information of patients was collected, and changes in the expression levels of IL-17, IL-10 and IL-6 were detected by enzyme-linked immunosorbent assay. Prolonged pregnancy time, success rate of fetal protection and average delivery time of patients were recorded. The adverse pregnancy conditions were compared, including the Apgar score of newborns, birth weight and adverse conditions, and postpartum hemorrhage volume and postpartum hospital stays in the two groups were recorded. Prolonged pregnancy time, success rate of fetal protection and average delivery time in the research group were significantly higher than those in the control group (P<0.05). After treatment, the levels of IL-17, IL-10 and IL-6 in serum of the two groups were significantly lower than those before treatment (P<0.05), and were significantly lower in the research group than in the control group (P<0.05). The average neonatal weight and Apgar score in the research group were significantly better than those in the control group (P<0.05). Postpartum hemorrhage, postpartum hospital stays and incidence rate of toxic side effects, neonatal death, malformation and asphyxia in the research group were significantly lower than those in the control group (P<0.05). Allylestrenol combined with ritodrine can significantly reduce the expression levels of IL-17, IL-10 and IL-6 in TPTL, reduce adverse pregnancy conditions, prolong gestational weeks, and has higher safety and better application value.

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Development and validation of predictive models for QUiPP App v.2: tool for predicting preterm birth in asymptomatic high‐risk women

Watson

Seed

Carter

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives Accurate mid‐pregnancy prediction of spontaneous preterm birth (sPTB) is essential to ensure appropriate surveillance of high‐risk women. Advancing the QUiPP App prototype, QUiPP App v.2 aimed to provide individualized risk of delivery based on cervical length (CL), quantitative fetal fibronectin (qfFN) or both tests combined, taking into account further risk factors, such as multiple pregnancy. Here we report development of the QUiPP App v.2 predictive models for use in asymptomatic high‐risk women, and validation using a distinct dataset in order to confirm the accuracy and transportability of the QUiPP App, overall and within specific clinically relevant time frames. Methods This was a prospective secondary analysis of data of asymptomatic women at high risk of sPTB recruited in 13 UK preterm birth clinics. Women were offered longitudinal qfFN testing every 2–4 weeks and/or transvaginal ultrasound CL measurement between 18 + 0 and 36 + 6 weeks' gestation. A total of 1803 women (3878 visits) were included in the training set and 904 women (1400 visits) in the validation set. Prediction models were created based on the training set for use in three groups: patients with risk factors for sPTB and CL measurement alone, with risk factors for sPTB and qfFN measurement alone, and those with risk factors for sPTB and both CL and qfFN measurements. Survival analysis was used to identify the significant predictors of sPTB, and parametric structures for survival models were compared and the best selected. The estimated overall probability of delivery before six clinically important time points (< 30, < 34 and < 37 weeks' gestation and within 1, 2 and 4 weeks after testing) was calculated for each woman and analyzed as a predictive test for the actual occurrence of each event. This allowed receiver‐operating‐characteristics curves to be plotted, and areas under the curve (AUC) to be calculated. Calibration was performed to measure the agreement between expected and observed outcomes. Results All three algorithms demonstrated high accuracy for the prediction of sPTB at < 30, < 34 and < 37 weeks' gestation and within 1, 2 and 4 weeks of testing, with AUCs between 0.75 and 0.90 for the use of qfFN and CL combined, between 0.68 and 0.90 for qfFN alone, and between 0.71 and 0.87 for CL alone. The differences between the three algorithms were not statistically significant. Calibration confirmed no significant differences between expected and observed rates of sPTB within 4 weeks and a slight overestimation of risk with the use of CL measurement between 22 + 0 and 25 + 6 weeks' gestation. Conclusions The QUiPP App v.2 is a highly accurate prediction tool for sPTB that is based on a unique combination of biomarkers, symptoms and statistical algorithms. It can be used reliably in the context of communicating to patients the risk of sPTB. Whilst further work is required to determine its role in identifying women requiring prophylactic interventions, it is a reliable and convenient screening tool for planning fol...

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

Abstract: Clinicians should acknowledge uncertainty, minimize conflicting information and advice, and promote continuity of care models for all women, including those attending high risk clinics and in the ward environment.

Cited by 29 publications

References 35 publications

Women who experience threatened preterm labour need early and accurate assessment, a clear management plan and continuity of care to reduce stress and anxiety

Women who experience threatened preterm labour need early and accurate assessment, a clear management plan and continuity of care to reduce stress and anxiety

Efficacy of allylestrenol combined with ritodrine on threatened premature labor and its influence on inflammatory factors in peripheral blood

Development and validation of predictive models for QUiPP App v.2: tool for predicting preterm birth in asymptomatic high‐risk women

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