Abdel-Aleem H, Shaaban OM, Abdel-Aleem MA. Cervical pessary for preventing preterm birth. Cochrane Database Syst Rev. 2013; 5:(5)

BMUS recommended Audit Tool – Explanatory notes.London: BMUS; 2014

Bujold E, Pasquier JC, Simoneau J Intra-amniotic sludge, short cervix, and risk of preterm birth. J Obstet Gynaecol Can. 2006; 28:(3)198-202

Burger M, Weber-Rössler T, Willmann M. Measurement of the pregnant cervix by transvaginal sonography: an inter-observer study and new standards to improve the inter-observer variability. Ultrasound Obstet Gynecol. 1997; 9:(3)188-93

Carter J, Gibson S, Hezelgrave N, Shennan AH. PPO.55 Full dilatation caesarean section and risk of subsequent preterm birth: a case series. Arch Dis Child Fetal Neonatal Ed. 2014; 99:A168.1-A168

Celik E, To M, Gajewska K, Smith GCS, Nicolaides KH Fetal Medicine Foundation Second Trimester Screening Group. Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment. Ultrasound Obstet Gynecol. 2008; 31:(5)549-54

Cervical Length Education And Review. Home. 2017. (accessed 4 April 2018)

Crane JMG, Healey S, O'Grady T, Splinter K, Hutchens D. Cervical assessment in women with hysteroscopic uterine septum resection: a retrospective cohort study. J Matern Fetal Neonatal Med. 2015; 28:(9)1068-72 109/14767058.2014.942635

Di Renzo GC, Cabero Roura L, Facchinetti F Preterm labor and birth management: recommendations from the European Association of Perinatal Medicine. J Matern Fetal Neonatal Med. 2017; 30:(17)2011-30 80/14767058.2017.1323860

Safer Maternity Care: The National Maternity Safety Strategy—Progress and Next Steps.London: DHSC; 2017

Esplin MS, O'Brien E, Fraser A Estimating recurrence of spontaneous preterm birth. Obstet Gynecol. 2008; 112:(3)516-23

Goldenberg RL, Culhane JF, Johnson DC. Maternal infection and adverse fetal and neonatal outcomes. Clin Perinatol1. 2005; 32:(3)523-59

Greco E, Gupta R, Syngelaki A, Poon LCY, Nicolaides KH. First-trimester screening for spontaneous preterm birth with maternal characteristics and cervical length. Fetal Diagn Ther. 2012; 31:(3)154-61

Hezelgrave NL, Watson HA, Ridout A Rationale and design of SuPPoRT: a multi-centre randomised controlled trial to compare three treatments: cervical cerclage, cervical pessary and vaginal progesterone, for the prevention of preterm birth in women who develop a short cervix. BMC Pregnancy Childbirth. 2016; 16:(1)

Honest H, Bachmann LM, Coomarasamy A, Gupta JK, Kleijnen J, Khan KS. Accuracy of cervical transvaginal sonography in predicting preterm birth: a systematic review. Ultrasound Obstet Gynecol. 2003; 22:(3)305-22

Kallioinen M, Eadon H, Murphy MS, Baird G Developmental follow-up of children and young people born preterm: summary of NICE guidance. BMJ. 2017; 358

Katz M, Goodyear K, Creasy RK. Early signs and symptoms of preterm labor. Am J Obstet Gynecol. 1990; 162:(5)1150-3

Kuhrt K, Smout E, Hezelgrave N, Seed PT, Carter J, Shennan AH. Development and validation of a predictive tool for spontaneous preterm birth incorporating cervical length and quantitative fetal fibronectin in asymptomatic high-risk women. Ultrasound Obstet Gynecol. 2016; 47:(1)104-9

Levine LD, Sammel MD, Hirshberg A, Elovitz MA, Srinivas SK. Does stage of labor at time of cesarean birth affect risk of subsequent preterm birth?. Am J Obstet Gynecol. 2015; 212:(3)360.e1-7

Malouf R, Redshaw M. Specialist antenatal clinics for women at high risk of preterm birth: a systematic review of qualitative and quantitative research. BMC Pregnancy Childbirth. 2017; 17:(1)

Mason GC, Maresh MJA. Alterations in bladder volume and the ultrasound appearance of the cervix. BJOG. 1990; 97:(5)457-8

Meijer-Hoogeveen M, Stoutenbeek P, Visser GHA. Dynamic cervical length changes: preliminary observations from 30-minute transvaginal ultrasound recordings. J Matern Fetal Neonatal Med. 2007; 20:(6)481-6

Min J, Watson HA, Hezelgrave NL, Seed PT, Shennan AH. Ability of a preterm surveillance clinic to triage risk of preterm birth: a prospective cohort study. Ultrasound Obstet Gynecol. 2016; 48:(1)38-42

Neale E. Cervical length assessment: How accurate are sonographers? MSc Dissertation.London: City University; 2011

Preterm labour and birth [NG25].London: NICE; 2015

National Institute of Child Health and Human Development. What are the risk factors for preterm labor and birth?. 2017. (accessed 4 April 2018)

Owen J, Hankins G, Iams JD Multi-center randomized trial of cerclage for preterm birth prevention in high-risk women with shortened mid-trimester cervical length. Am J Obstet Gynecol. 2009; 201:(4)375.e1-8

Reproductive Outcomes after Local Treatment for Preinvasive Cervical Disease [Scientific Impact Paper Number 21].London: RCOG; 2016

Quality assurance in Radiology reporting: peer review feedback.London: RCR; 2014

Sharp AN, Alfirevic Z. Provision and practice of specialist preterm labour clinics: a UK survey of practice. BJOG. 2013; 121:(4)417-21

McIntosh J, Feltovich H, Berghella V, Manuck T The role of routine cervical length screening in selected high-and low-risk women for preterm birth prevention. Am J Obstet Gynecol. 2016; 215:(3)B2-7

Clinical Practice Guideline (May 2011) Ultrasonographic cervical length assessment in predicting preterm birth in singleton pregnancy Journal of Obstetrics and Gynaecology Canada. 2011; 33:(5)486-99

To MS, Skentou C, Chan C, Zagaliki A, Nicolaides KH. Cervical assessment at the routine 23-week scan: standardizing techniques. Ultrasound Obstet Gynecol. 2001; 17:(3)217-19

Valentin L, Bergelin I. Intra-and inter-observer reproducibility of ultrasound measurements of cervical length and width in the second and third trimesters of pregnancy. Ultrasound Obstet Gynecol. 2002; 20:(3)256-62

Wood SL, Tang S, Crawford S. Cesarean birth in the second stage of labor and the risk of subsequent premature birth. Am J Obstet Gynecol. 2017; 217:(1)63.e1-10

Zimmer EZ, Bardin R, Tamir A, Bronshtein M. Sonographic imaging of cervical scars after Cesarean section. Ultrasound Obstet Gynecol. 2004; 23:(6)594-8

Introducing a preterm surveillance clinic to manage high-risk women

02 May 2018
Volume 26 · Issue 5


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).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month