Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 121, Issue 4, Pages 417-421Publisher
WILEY-BLACKWELL
DOI: 10.1111/1471-0528.12512
Keywords
Cerclage; cervix; preterm birth; specialist antenatal clinic; transvaginal ultrasound
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ObjectiveTo identify the current status of specialist preterm labour (PTL) clinic provision and management within the UK. DesignPostal survey of clinical practice. SettingUK PopulationAll consultant-led obstetric units within the UK. MethodsA questionnaire was sent by post to all 210 NHS consultant-led obstetric units within the UK. Units that had a specialist PTL clinic were asked to complete a further 20 questions defining their protocol for risk stratification and management. Main outcome measuresCurrent practice in specialist preterm labour clinics.. ResultsWe have identified 23 specialist clinics; the most common indications for attendance were previous PTL (100%), preterm prelabour rupture of membranes (95%), two large loop excisions of the transformation zone (95%) or cone biopsy (95%). There was significant heterogeneity in the indications for and method of primary treatment for short cervix, with cervical cerclage used in 45% of units, progesterone in 18% of units and Arabin cervical pessary in 5%. A further 23% used multiple treatment modalities in combination. ConclusionsA significant heterogeneity in all topics surveyed suggests an urgent need for networking, more evidence-based guidelines and prospective comparative audits to ascertain the real impact of specialist PTL clinics on the reduction in preterm birth and its sequelae.
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