PRE-TERM BIRTH CLINIC REFERRALS AND OUTCOMES

Over 52,000 babies (around 7.3% of live births) in England and Wales in 2012 were born preterm. Preterm birth causes significant neonatal morbidity and mortality, as well as long-term disability.

Strategies for preventing preterm birth are important.

Objective

Dedicated preterm surveillance clinics have been shown to be an effective way of managing high-risk women.Preterm birth clinic was started in DPOW since July 2021. This study was planned to discuss the practicalities of establishing a dedicated preterm surveillance clinic, including identification of high-risk women and appropriate referral, what surveillance can be offered and suggested management pathways.

Design

Retrospective analysis of patient cohort referred to pre-term birth clinic

Method

Patients were identified from clinic lists for a period of 6months July 2021- January 2022, case and notes and electronic database studied for relevant details and data evaluated on excel.

Results

Total of 43 cases, 6 excluded as not appropriate. (July 2021 – January 2022) 37 cases assessed.

Majority were in the age group of 30-34 years followed by 25-29 years.

Majority (51.5%) had parity 1.

2/3rd of the cases were referred to the clinic by 12 weeks.

51% (19/37) were referred for previous pre-term delivery, 22% (8/37) for previous pre-term pre-labour rupture of membrane (PPROM), 22% for LLETZ (large loop excision of transformation zone) (8/37) and 5% (2/37) uterine anomaly.

Cervical length scan was done in 84% (31/37), missed in 11% (4/37) and 2.5% (1/37) not applicable and 2.5% (1/37) declined.

. 

76% (28/37) delivered >37 weeks, 22% (8/37) delivered pre-term and one case transferred out of area. 73% (27/37) had vaginal delivery; 19% (7/37) had emergency caesarean section; 5% (2/37) elective caesarean; one case transferred out of area. 

Assessment of Pre-term deliveries in this cohort showed total 8/37 had preterm delivery. 60% were spontaneous and no clear cause identified and had received appropriate intervention. One case had cervical cerclage, low lying placenta, had PPROM at 25 weeks and  emergency caesarean at 28 weeks for abnormal CTG and fetal malposition, 2 further cases presented in pre-term labour and had emergency caesarean for pathological CTG.

Summary

 MSU culture was performed in 92% and 100% with abnormal result was treated

 20 patients (54%) were eligible for progesterone pessaries; 40% (8/20) were offered and rest 60% (12/20) were not offered or no documentation.