Optimising the care of women at high risk of spontaneous preterm birth

Abstract

Background Preterm birth is the leading cause of neonatal death and has lifelong health consequences for many survivors. The majority of cases are a consequence of the spontaneous onset of labour. Aims To identify strategies that optimise the care of women at high risk of spontaneous preterm birth. Methods Vaginal biomarker use in symptomatic women 1. A quality improvement project assessed the effect of a multi-faceted implementation programme on compliance with the use of a fetal fibronectin clinical practice guideline. 2. A prospective observational study compared the impact of different vaginal biomarker tests on clinical care. Preterm birth clinics 3. A systematic review assessed current practice in preterm birth clinics worldwide. 4. An observational study reviewed five years of practice in the first preterm birth clinic in New Zealand. 5. A longitudinal cohort survey assessed the psychological wellbeing of women attending a preterm birth clinic and the potential impact of clinic care on their wellbeing. Birth at peri-viable gestations 6. A single-centre case series assessed antenatal counselling and perinatal care for babies born at 23-24 weeks over a two year period. Results Vaginal biomarker use in symptomatic women 1. A multi-faceted implementation programme improves compliance to a clinical practice guideline. 2. Use of quantitative fFN could decrease the rate of antenatal admissions without compromising care for babies born preterm. Preterm birth clinics 3. There is wide variation in practice in preterm birth clinics. 4. Most women underwent cervical surveillance as their primary management. Pregnancy outcomes were consistent with published literature. 5. Women seen in preterm birth clinics have high rates of anxiety. Anxiety reduced over time whilst attending the clinic. Women’s perceptions of clinic care were favourable. Birth at peri-viable gestations 6. All families opted for active intervention when this was offered. Some aspects of care can be improved, including magnesium sulphate administration, delayed cord clamping and documentation of plans for delivery. Conclusions There are opportunities to optimise the care of women at high risk of spontaneous preterm birth. Findings will contribute to the development of a national preterm birth prevention programme for New Zealand.