Liggins Institute, The University of Auckland, Private Bag 92019, Victoria Street West, Auckland, 1142, New Zealand.
National Women's Health, Auckland City Hospital, Auckland, New Zealand.
BMC Pregnancy Childbirth. 2020 Jan 29;20(1):58. doi: 10.1186/s12884-020-2731-7.
Specialised preterm birth clinics care for women at high risk of spontaneous preterm birth. This systematic review assesses current practice within preterm birth clinics globally.
A comprehensive search strategy was used to identify all studies on preterm birth clinics on the MEDLINE, Embase, PsycINFO, CENTRAL and CINAHL databases. There were no restrictions to study design. Studies were limited to the English language and publications from 1998 onwards. Two reviewers assessed studies for inclusion, performed data extraction and reviewed methodological quality. Primary outcomes were referral criteria, investigations and interventions offered in preterm birth clinics. Secondary outcomes were the timing of planned first and last appointments and frequency of review.
Thirty-two records fulfilled eligibility criteria and 20 studies were included in the main analysis following grouping of records describing the same study or clinic. Studies were of mixed study design and methodological quality. A total of 39 clinics were described; outcome data was not available for all clinics. Referral criteria included previous spontaneous preterm birth (38/38, 100%), previous mid-trimester loss (34/38, 89%) and previous cervical surgery (33/38, 87%). All clinics offered transvaginal cervical length scans. Additional investigations varied, including urogenital swabs (16/28, 57%) and fetal fibronectin (8/28, 29%). The primary treatment of choice for a sonographic short cervix was cervical cerclage in 10/33 (30%) clinics and vaginal progesterone in 6/33 (18%), with 10/33 (30%) using multiple first-line options and 6/33 (18%) using a combination of treatments. The majority of clinics planned timing of first review for 12-16 weeks (30/35, 86%) and the frequency of review was usually determined by clinical findings (18/24, 75%). There was a wide variation in gestational age at clinic discharge between 24 and 37 weeks.
There is variation in the referral criteria, investigations and interventions offered in preterm birth clinics and in the timing and frequency of review. Consistency in practice may improve with the introduction of consensus guidelines and national preterm birth prevention programmes.
Systematic review registration number: CRD42019131470.
专门的早产诊所为有自发性早产高风险的妇女提供护理。本系统评价评估了全球早产诊所的当前实践情况。
使用全面的搜索策略在 MEDLINE、Embase、PsycINFO、CENTRAL 和 CINAHL 数据库中查找所有关于早产诊所的研究。研究设计不受限制。研究仅限于英语出版物和 1998 年以后的出版物。两名评审员评估研究的纳入情况、进行数据提取并审查方法学质量。主要结局是早产诊所提供的转诊标准、检查和干预措施。次要结局是计划的首次和末次预约的时间以及复查的频率。
有 32 条记录符合入选标准，在对描述同一研究或诊所的记录进行分组后，有 20 项研究纳入主要分析。研究设计和方法学质量混合。共描述了 39 家诊所；并非所有诊所都提供了结局数据。转诊标准包括既往自发性早产（38/38，100%）、既往中孕期流产（34/38，89%）和既往宫颈手术（33/38，87%）。所有诊所均提供经阴道宫颈长度扫描。其他检查包括尿生殖拭子（16/28，57%）和胎儿纤维连接蛋白（8/28，29%）。对于超声检查发现宫颈短的首选治疗方法，10/33（30%）家诊所选择宫颈环扎术，6/33（18%）家诊所选择阴道用孕酮，10/33（30%）家诊所使用多种一线治疗方法，6/33（18%）家诊所使用联合治疗方法。大多数诊所计划在 12-16 周（30/35，86%）进行首次复查，复查频率通常根据临床发现确定（18/24，75%）。诊所出院时的孕龄在 24-37 周之间有很大差异。
早产诊所提供的转诊标准、检查和干预措施以及复查的时间和频率存在差异。随着共识指南和国家早产预防计划的引入，实践的一致性可能会得到改善。
系统评价注册号：CRD42019131470。
