Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia.
Pregnancy Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia.
J Perinat Med. 2021 May 21;49(9):1048-1057. doi: 10.1515/jpm-2021-0020. Print 2021 Nov 25.
Preterm birth clinics provide dedicated obstetric care to women at high risk of spontaneous preterm birth (SPTB). There remains a lack of conclusive evidence to support the overall utility of such clinics, attributable to a paucity and heterogeneity of primary data. This study audits Australia's largest and oldest dedicated preterm birth clinic with the aim to add primary data to the area and offer opportunities for similar clinics to align practice.
A retrospective audit of referrals to the Preterm Labour Clinic at the Royal Women's Hospital, Melbourne, Australia, between 2004 and 2018 was conducted. 1,405 singleton pregnancies met inclusion criteria. The clinic's key outcomes, demographics, predictive tests and interventions were analysed. The primary outcomes were SPTB before 37, 34 and 30 weeks' gestation.
The overall incidence of SPTB in the clinic was 21.2% (n=294). Linear regression showed reductions in the adjusted rates of overall SPTB and pre-viable SPTB (delivery <24 weeks) from 2004 (108%; 8%) to 2018 (65%; 2% respectively). Neonatal morbidity and post-delivery intensive care admission concurrently declined (p=0.02; 0.006 respectively). Rates of short cervix (cervical length <25 mm) increased over time (2018: 30.9%) with greater uptake of vaginal progesterone for treatment. Fetal fibronectin, mid-trimester short cervix, and serum alkaline phosphatase were associated with SPTB on logistic regression.
Dedicated preterm birth clinics can reduce rates of SPTB, particularly deliveries before 24 weeks' gestation, and improve short-term neonatal outcomes in pregnant women at risk of preterm birth.
早产门诊为自发性早产（SPTB）高危孕妇提供专门的产科护理。由于初级数据的缺乏和异质性，仍然缺乏支持此类门诊整体效用的确凿证据。本研究对澳大利亚最大和最古老的专门早产门诊进行了回顾性审计，旨在为该领域增加初级数据，并为类似的门诊提供实践趋同的机会。
对澳大利亚墨尔本皇家妇女医院早产门诊 2004 年至 2018 年的转诊情况进行了回顾性审计。符合纳入标准的 1405 例单胎妊娠。分析了该门诊的关键结局、人口统计学、预测性检查和干预措施。主要结局是 37 周、34 周和 30 周前的 SPTB。
该门诊的 SPTB 总发生率为 21.2%（n=294）。线性回归显示，从 2004 年（108%；8%）到 2018 年（65%；2%），整体 SPTB 和有生机儿前 SPTB（分娩<24 周）的调整发生率均有所下降。同时，新生儿发病率和产后重症监护病房入院率也有所下降（p=0.02；0.006 分别）。短宫颈（宫颈长度<25 毫米）的发生率随着时间的推移而增加（2018 年：30.9%），阴道用孕激素治疗的比例也有所增加。逻辑回归显示，胎儿纤连蛋白、中期短宫颈和血清碱性磷酸酶与 SPTB 相关。
专门的早产门诊可以降低 SPTB 的发生率，特别是 24 周前的分娩率，并改善有早产风险的孕妇的短期新生儿结局。
