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

Lisa Dawes,Katie Groom,Vanessa Jordan,Jason Waugh

doi:10.1186/s12884-020-2731-7

Abstract

BackgroundSpecialised preterm birth clinics care for women at high risk of spontaneous preterm birth. This systematic review assesses current practice within preterm birth clinics globally.MethodsA 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.ResultsThirty-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.ConclusionsThere 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 registrationSystematic review registration number: CRD42019131470.

Highlights

Preterm birth is the leading cause of neonatal death and is associated with significant perinatal morbidity and lifelong health consequences [1]
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
Preterm birth clinics are known as preterm birth prevention clinics, preterm surveillance clinics, specialised preterm birth clinics, dedicated preterm birth clinics, miscarriage follow-up clinics and specialised antenatal clinics

Summary

Introduction

Preterm birth is the leading cause of neonatal death and is associated with significant perinatal morbidity and lifelong health consequences [1]. Preterm birth is common and accounts for approximately 10% of births worldwide [1]. At least half of all preterm births are the result of spontaneous onset of labour or pre-labour rupture of membranes [2]. Despite considerable research efforts there is no effective treatment to stop preterm labour once it has established and current management focuses on prevention [3, 4]. In recent years, specialised preterm birth clinics have developed due to a growing understanding of risk factors for preterm birth and the importance of risk stratification to guide the use of interventions to prevent preterm labour [5]. To the best of our knowledge, the first modern-day preterm birth clinic was established in the United Kingdom (UK) in 1998. This systematic review assesses current practice within preterm birth clinics globally

Objectives

Methods

Results

Discussion

Conclusion