Controlled trial of a Preterm Labor Detection program: efficacy and costs

Abstract

Patient education regarding the signs and symptoms of preterm labor combined with frequent clinical evaluations has been advocated as a means to reduce preterm births. Over a 3.5-year period, the risk for preterm labor was determined in 943 indigent black inner-city women using the Papiernik-Creasy scoring system. High-risk women were allocated randomly to a Preterm Labor Detection Clinic or to serve as high-risk controls. Women with lower risk scores served as low-risk controls. Women from both control groups were not informed of their risk status, and both groups received prenatal care in standard obstetric clinics. Women accepting the Preterm Labor Detection Clinic Program received comprehensive patient education and were seen weekly starting at 22 weeks' gestation. Despite this extensive outpatient program, there were no significant differences between the high-risk groups with respect to mean gestational age at delivery, mean birth weight, or percentage delivering before term as a result of preterm labor or premature rupture of membranes (PROM). Evaluations of inpatient charges revealed no significant differences due to participation in this program, although outpatient clinic utilization and charges were increased significantly for Preterm Labor Detection Clinic patients. Failure of this program to reduce preterm birth may relate to the relatively low overall rate of women presenting in preterm labor with advanced cervical dilation. In contrast, high rates of PROM and fetal death occurred in all three study groups.