Provision and practice of specialist preterm labour clinics: a UK survey of practice

Abstract

Objective: To identify the current status of specialist preterm labour (PTL) clinic provision and management within the UK.

Design: Postal survey of clinical practice.

Setting uk population: All consultant-led obstetric units within the UK.

Methods: A questionnaire was sent by post to all 210 NHS consultant-led obstetric units within the UK. Units that had a specialist PTL clinic were asked to complete a further 20 questions defining their protocol for risk stratification and management.

Main outcome measures: Current practice in specialist preterm labour clinics.

Results: We have identified 23 specialist clinics; the most common indications for attendance were previous PTL (100%), preterm prelabour rupture of membranes (95%), two large loop excisions of the transformation zone (95%) or cone biopsy (95%). There was significant heterogeneity in the indications for and method of primary treatment for short cervix, with cervical cerclage used in 45% of units, progesterone in 18% of units and Arabin cervical pessary in 5%. A further 23% used multiple treatment modalities in combination.

Conclusions: A significant heterogeneity in all topics surveyed suggests an urgent need for networking, more evidence-based guidelines and prospective comparative audits to ascertain the real impact of specialist PTL clinics on the reduction in preterm birth and its sequelae.

Keywords: Cerclage; cervix; preterm birth; specialist antenatal clinic; transvaginal ultrasound.