298: Assessing the need for subsequent pregnancy education at time of spontaneous preterm delivery

Abstract

The strongest risk factor for preterm birth (PTB) is history of prior PTB. Despite interventions such as cerclage and 17 alpha-hydroxyprogesterone caproate (17 OHP-C), the rate of PTB has not significantly decreased. Lack of follow up postpartum (PP) visits and preconception counseling may be attributing to limited familiarity of PTB prevention. We sought to assess the knowledge of treatments and management for subsequent pregnancies in women with history of PTB. We conducted a qualitative study using a confidential telephone survey of women who had a PTB between July 2016-March 2018 at a tertiary care center. Maternal and fetal indications that prompted iatrogenic preterm delivery were excluded. Recorded data was analyzed to assess the following: 1) knowledge of cerclage and/or 17 OHP-C, 2) PTB prevention counseling in immediate PP period, 3) contraceptive counseling in immediate PP period, and 4) interest in receiving education on PTB prevention. Of 525 women who had spontaneous PTB, 70 agreed to participate in the survey. Twenty-three (33%) women had heard about 17 OHP-C and cerclage, though 11 (48%) of those women had already had a subsequent pregnancy with one or both of their use. Fifty-six (80%) women received immediate PP contraceptive counseling, however, only 19 (27%) women received immediate PP PTB prevention counseling. Fifty-two (74%) women reported they would have liked to receive PTB prevention counseling at time of their delivery. Forty-nine (70%) women reported they would be interested in receiving educational material if such become available. The most common reason provided for not wanting education or PTB prevention counseling was no longer desiring future pregnancy. The majority of women with history of PTB are not aware of existing interventions to prevent PTB. Counseling in the immediate PP period after PTB is not frequently provided but is sought after by women. These findings suggest that there is a need to provide counseling and educational resources in the immediate PP period to women who have PTB and desire subsequent pregnancies.