Introduction 8% of live births in the UK are preterm births (PTB) accounting for significant perinatal mortality and long-term morbidity. While prediction of preterm birth is complex, the Preterm Surveillance Clinic (PSC) at St Thomas' Hospital combines history, ultrasonographic cervical length and fetal fibronectin to screen and admit those thought as highest risk of early delivery for appropriate interventions.
Aims To identify whether the PSC accurately risk-stratifies asymptomatic high-risk women, by comparing outcomes of those admitted to those managed as outpatients.
Method Prospectively collected observational study of 426 consecutive, asymptomatic, high-risk women, analysed according to admission, gestational age at delivery and neonatal outcome. Categorical variables are compared using chi-square.
Results 91% (n=390) of high-risk women seen in clinic are not admitted and 885% (n=330) of those deliver >37 weeks. Those admitted to hospital delivered significantly earlier than those managed as outpatients; 33.3% vs. 2.6% (<30 weeks), and 77.8% vs.15.4% (<37 weeks). The infants of those admitted had significantly greater rates of neonatal-ICU admissions, lower Apgar scores, respiratory distress syndrome and low birth-weight (<2.5kg).
Conclusion PSC can accurately risk-stratify asymptomatic women at high-risk of PTB. Women who were not admitted had similar outcomes to our background population. Interventions can therefore be targeted to those who need it. Further research is needed to assess the value of preterm screening.
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