Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.
Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.
PLoS One. 2020 Jun 4;15(6):e0234033. doi: 10.1371/journal.pone.0234033. eCollection 2020.
In 2014, a whole-of-population and multi-faceted preterm birth prevention program was introduced in Western Australia with the single aim of safely lowering the rate of preterm birth. The program included new clinical guidelines, print and social media, and a dedicated new clinic. In the first full calendar year the rate of preterm birth fell by 7.6% and the reduction extended from the 28-31 week gestational age group upwards.
The objective of this study was to evaluate outcomes in greater depth and to also include the first three years of the program.
This was a prospective population-based cohort study of perinatal outcomes in singleton pregnancies before and after commencement of the program.
There was a significant reduction in preterm birth in the tertiary center which extended from 28 weeks gestation onwards and was ongoing. In non-tertiary centers there was an initial reduction, but this was not sustained past the first year. The greatest reduction was observed in pregnancies classified at first attendance as low risk. No benefit was observed in the private sector, but a significant reduction was seen in the remote region of the Kimberley where the program was first launched and vaginal progesterone had been made free-of-charge.
Preterm birth rates can be safely reduced by a multi-faceted and whole-of-population program but the effectiveness requires continuing effort and will be greatest where the strategies are most targeted.
2014 年，西澳大利亚州推出了一项全人群多方面的早产预防计划，其唯一目的是安全降低早产率。该计划包括新的临床指南、印刷和社交媒体，以及一个专门的新诊所。在第一个完整的日历年内，早产率下降了 7.6%，降幅从 28-31 孕周组向上延伸。
本研究的目的是更深入地评估结果，并将其扩展到该计划的头三年。
这是一项在该计划启动前后对单胎妊娠围产期结局进行的前瞻性基于人群的队列研究。
在三级中心，早产率显著下降，从 28 周妊娠开始并持续下降。在非三级中心，最初有下降，但在第一年之后没有持续。在最初被归类为低风险的妊娠中观察到最大的降幅。在私营部门没有观察到益处，但在该计划首次推出且阴道孕酮免费的金伯利偏远地区，显著降低。
通过多方面的全人群计划可以安全降低早产率，但有效性需要持续努力，并且在策略最具针对性的地方效果最佳。
