Introducing a preterm surveillance clinic to manage high-risk women
Preterm birth, or birth before 37 weeks, is a leading cause of morbidity and mortality in babies. Dedicated preterm surveillance clinics have been shown to be an effective way of managing high-risk women. Given the lack of national guidance on the specifics of preterm surveillance, the aim of this article is to discuss the practicalities of establishing a dedicated preterm surveillance clinic; specifically how to identify high-risk women, what surveillance can be offered, how to standardise the transvaginal ultrasound cervical assessment, and suggested management pathways.
Preterm birth, or birth before 37 weeks gestation, is known to cause short and long term problems. Preterm babies are more at risk of developmental problems and disorders; a risk known to lessen with advancing gestational age (Kallioinen et al, 2017). In England and Wales, around 7.5% of babies are born preterm, with 0.4% born before 28 weeks (Kallioinen et al, 2017). Further details regarding the Department of Health and Social Care's (DHSC) vision for reducing the national preterm birth rate and improving maternity care can be found in the Safer Maternity Care policy (DHSC, 2017)
In 2016, Rosie Hospital, Cambridge had 5688 births, with 381 women (6.7%) having spontaneous preterm deliveries. Although this is below the national level, it still presents a significant demand for future screening of high-risk women in their subsequent pregnancies. Previously, high-risk women were seen in the antenatal clinic and referred to the scan department for cervical length screening. An audit was carried out, which demonstrated variation in both the referral and management of these women. As a result of the audit, guidelines from the National Institute for Health and Care Excellence (NICE) (2015), and patient feedback, the preterm surveillance clinic was established. Dedicated preterm surveillance clinics are not widely available in all UK obstetric units: Sharp and Alfirevic (2013) found that only 23 of 144 (15.0%) of NHS hospitals had specialist clinics, despite evidence suggesting that they are an effective way of managing high-risk women and avoid unnecessary admissions (Min et al, 2016). Dedicated preterm clinics may also provide emotional and psychological benefits for women through improved continuity of care (Malouf and Redshaw, 2017).
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