Liggins Institute, The University of Auckland, Auckland, New Zealand.
National Women's Health, Auckland City Hospital, Auckland, New Zealand.
Aust N Z J Obstet Gynaecol. 2020 Dec;60(6):904-913. doi: 10.1111/ajo.13176. Epub 2020 May 18.
A greater understanding of the risk factors for spontaneous preterm birth and the importance of risk stratification to guide interventions has led to the introduction of preterm birth prevention clinics.
To evaluate the experience and outcomes of the first specialised preterm birth clinic in New Zealand.
This observational study reviewed pregnancies cared for in a preterm birth clinic from 2013 to 2018. Cases were identified and data collected from a maternity database and electronic medical records. Analysis was by referral type.
A total of 423 cases were included; 309 elective and 22 acute referrals in pregnancy, and 92 consultations outside pregnancy. For those referred electively in pregnancy, 138/309 (44.7%) fulfilled multiple referral criteria, and 57/309 (18.4%) had ≥2 previous spontaneous preterm births or second trimester losses. Excluding five pregnancies with first trimester miscarriage, 77/304 (25.3%) were managed with a history-indicated cerclage (11 placed pre-conception) and 217/304 (71.4%) had cervical surveillance as primary management, of which 133 (61.3%) did not require treatment. The remaining had treatment for a short cervix; 37 (17.0%) received an ultrasound-indicated cerclage only, 21 (9.7%) vaginal progesterone only and 26 (12.0%) both. Five women (1.6%) had a second trimester loss at 13 -19 and 58/297 (19.5%) had a spontaneous preterm birth at 20 -36 weeks. The 'take home baby' rate was 95.4%.
Pregnancy outcomes were similar to those reported by other preterm birth prevention clinics. The majority of women who received cervical surveillance as primary management were able to avoid additional treatment.
对自发性早产风险因素的更深入了解以及对风险分层以指导干预的重要性，导致了早产预防诊所的出现。
评估新西兰首个专门的早产诊所的经验和结果。
这项观察性研究回顾了 2013 年至 2018 年在早产诊所接受治疗的妊娠情况。通过产妇数据库和电子病历识别病例并收集数据。分析按转诊类型进行。
共纳入 423 例病例；22 例在妊娠期间为急性转诊，309 例为选择性转诊，92 例为妊娠外就诊。对于在妊娠期间选择性转诊的病例，138/309（44.7%）符合多项转诊标准，57/309（18.4%）有≥2 次自发性早产或中孕期流产史。排除 5 例妊娠早期流产，77/304（25.3%）采用病史提示性宫颈环扎术（11 例孕前放置），217/304（71.4%）采用宫颈监测作为主要管理方法，其中 133 例（61.3%）无需治疗。其余的因宫颈短接受治疗；37 例（17.0%）仅接受超声提示性宫颈环扎术，21 例（9.7%）仅阴道用孕酮，26 例（12.0%）两者均用。5 例（1.6%）在 13-19 周时发生中孕期流产，58/297（19.5%）在 20-36 周时发生自发性早产。“带婴儿回家”率为 95.4%。
妊娠结局与其他早产预防诊所报告的结果相似。大多数接受宫颈监测作为主要管理的女性能够避免额外的治疗。
