PRETERM BIRTH PREVENTION CLINIC OUTCOMES
By Jazmin Gajadhar, Epsom and St Helier NHS Hospitals
Objective:
Evaluation of outcomes of pregnancies managed in a midwife/sonographer led preterm birth prevention clinic over a period of 1 year (280 patients).
Methods:
The hospital serves a multi-ethnic population in south London and Surrey. Annual births vary between 3900-4400 births.
All women had a screening for risk of preterm birth at 11-13 weeks.
Criteria:
This was a single assessment at 20 weeks or serial assessments between 12-22 weeks.
All data was prospectively collected in a database which included maternal characteristics, previous obstetric history, screening results, treatment offered and the pregnancy outcomes.
Births before 23/40: miscarriages. Preterm birth: 23+0 and 36+6/40.
Results:
Most Common referral: Previous LLETZ procedure. 159/280 patients – 57%
• Number of single scan assessments: 52 patients – 19%
• Number of multiple scan assessments. 228 patients - 81%
• Number of cases that saw cervical shortening despite use of progesterone: 6 patients – 2.14)
• Number offered cx stitch based on history: 5 patients – 1.79%
• Number offered cx stitch based on evidence of shortening: 2 Patients – 0.71%
• Number with PPROM: 7 patients – 2.5%
• Number with PPROM with cx cerclage : 1 patient – 0.36%
• Number with PPROM with no cx cerclage: 7 Patients – 2.5%
• Number with birth at 23+0 to 36+0 weeks: 10%
• Number with birth <34 +0 weeks: 4%
Outcomes:
Risk reduction: 32/280 (11.43%) had a preterm delivery and 10/280 (3.57%) had a subsequent preterm delivery.
18/280 (6.43%) had a late miscarriage and 5/280 (1.79%) had a repeat late miscarriage.
Conclusion: The clinic can improve outcomes in pregnancy by focusing on high-risk cases. A pre-defined protocol allows for the clinic to run with indirect supervision.
LLETZ procedure as a risk factor needs to be re-evaluated. 2% of patients referred with previous LLETZ x1 or more had a preterm delivery before 37 weeks, 98% had term deliveries.