Specialty Care Clinic Aids Women at Risk for Spontaneous Preterm Birth

Spontaneous preterm birth, the most common cause of premature birth, results from a multifactorial process. Its etiology is unknown, which makes it difficult to treat. In addition, there are few proven preventive measures.

To better serve this patient population, researchers from the division of maternal-fetal medicine in the department of obstetrics and gynecology at the University of Utah School of Medicine and Intermountain Healthcare in Salt Lake City sought to determine if treatment at a specialty clinic aimed at preventing spontaneous preterm birth would prove to be more effective than standard care and therefore result in lower rates of recurrent prematurity.

Dr Tracy Manuck, maternal-fetal medicine fellow, and colleagues conducted a retrospective cohort study of 223 women with a single, nonanomalous fetus of at least 20 weeks’ gestation who had at least one documented previous spontaneous preterm birth (PTB) of less than 35 weeks’ gestational age. Women were identified through a large database covering 17 Utah hospitals within the Intermountain Healthcare system. Women who were referred to the specialty PTB clinic (n = 70) were compared with women receiving usual care from their current care provider (n = 153).

The recurrent PTB clinic offers referring clinicians and their patients with a history of PTB additional resources and support. While attending the program, patients remained under the care of their referring clinician. Patients received 3 prescribed visits during specific points of their pregnancy; additional visits were available as clinically indicated. The clinic conducted urinalysis and transvaginal ultrasound for cervical length at each visit and prescribed standardized treatment when results warranted such. Patients were offered intramuscular injections of prophylactic17-alpha hydroxyprogesterone caproate (250 mg); when patients took advantage of this treatment, it was administered weekly beginning at 16 weeks’ gestation and continued through 36 weeks’ gestation. Medications, bed rest, and hospitalization were prescribed as needed based on the results of each visit.

The researchers found overall neonatal outcomes to be good in both cohorts, with a late mean delivery age (34 to 36 weeks). However, the researchers determined that participation in the recurrent PTB prevention clinic was associated with a 28% reduced risk of recurrent spontaneous PTB. Specifically, the rate of recurrent spontaneous PTB (< 37 weeks) for women participating in the PTB clinic was 48.6% compared to 63.4% in the usual-care group (p = 0.04). In addition, very early spontaneous PTB (defined as < 32 weeks) was more prevalent in the usual-care group as compared to the clinic group (13.7% versus 5.7%), but this result was not statistically significant. While neonatal intensive care rates were similar among the groups, the rates of major neonatal morbidity were lower among those who attended the clinic than those from the usual care group (5.7% versus 16.3%).

“We hypothesize that the recurrent PTB prevention clinic is associated with improved outcomes due to the combination of increased utilization of resources (eg, 17OHPC, serial monitoring of cervical length) as well as specific evidence-based counseling both to the subjects and their primary obstetricians,” the researchers concluded. “Establishing similar recurrent PTB prevention clinics in other health care systems, as well as focusing on additional potentially modifiable risk factors for PTB, may help to lower the overall rate of spontaneous prematurity and improve neonatal outcomes.”

More Information

Preterm Labor: Take Prevention SeriouslyMarch of Dimes: Premature Birth

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Reference

Manuck TA, Henry E, Gibson J, et al. Pregnancy outcomes in a recurrent preterm birth prevention clinic. [http://www.ncbi.nlm.nih.gov/pubmed/21345407] Am J Obstet Gynecol. 2011; 204(4):320.e1-6.