Introduction Prematurity is the leading cause of neonatal morbidity and mortality. However threatened pre-term labour is common and it is difficult to distinguish the subset of women who will deliver. We assessed the utilisation of pre-term labour tests in England and evaluated factors that contribute to their availability in maternity units.

Methods An online survey was sent to 166 maternity units across England. The overall response rate was 32.5% (54 units). Data were analysed quantitatively using contingency tables, and qualitatively using Geomapping software.

Results Data were evenly distributed geographically. The most commonly utilised test was fetal fibronectin (52.83%, CI 32.65-58.55), followed by cervical length measurement (39.62%, CI 27.52-52.08) and Actim Partus (24.52%, CI 14.8 –37.69). 26.4% (CI 16.34–39.68) of units utilised more than one test for pre-term labour.

14 units did no testing for pre-term labour (13.21%, CI 6.21-25.15). These units tended to have higher levels of neonatal care available on site than those that did test, but this association did not reach significance (p=0.0826).

The most commonly cited barriers to testing were cost (28.3%, CI 17.88-41.56) and inexperience of operators (18.87%, CI 10.39-31.56).

84% (C1 71.46-92.37) of units made discharge decisions and 93.47% (CI 81.85-98.41) undertook intrauterine transfer on the basis of test results.

Conclusions This study is the first to identify the proportion of English maternity units that test for likelihood of delivery in pre-term labour. Our results suggest that larger obstetric units may be under-utilising these tests. This may have important implications for neonatal cot management.