Women’s Health Bulletin

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The Role of PTB Clinics: A Review of the Screening Methods, Interventions and Evidence for Preterm Birth Surveillance Clinics for High-Risk Asymptomatic Women

Gabrielle Vernet 1 , * , Helena Watson 1 , Alex Ridout 1 and Andrew Shennan 1
Authors Information
1 Women’s Health Academic Centre, Kings College London, London, UK
Article information
  • Women’s Health Bulletin: October 2017, 4 (4); e12667
  • Published Online: September 18, 2017
  • Article Type: Review Article
  • Received: March 12, 2017
  • Revised: May 6, 2017
  • Accepted: July 19, 2017
  • DOI: 10.5812/whb.12667

To Cite: Vernet G, Watson H, Ridout A, Shennan A. The Role of PTB Clinics: A Review of the Screening Methods, Interventions and Evidence for Preterm Birth Surveillance Clinics for High-Risk Asymptomatic Women, Women Health Bull. 2017 ; 4(4):e12667. doi: 10.5812/whb.12667.

Abstract
Copyright © 2017, Women’s Health Bulletin. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Context
2. Methods
3. Aetiology and Risk factors for PTB
4. The role of Preterm Birth Surveillance Clinics
5. How Effective Are PTB Surveillance Clinics
6. Conclusion and Considerations for the Future
Footnote
References
  • 1. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013; 10 Suppl 1[DOI][PubMed]
  • 2. Moser K, Stanfield KM, Leon DA. Birthweight and gestational age by ethnic group, England and Wales 2005: introducing new data on births. Health Stat Q. 2008; (39): 22-31[PubMed]
  • 3. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008; 371(9606): 75-84[DOI][PubMed]
  • 4. Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008; 371(9608): 261-9[DOI][PubMed]
  • 5. Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics. 2006; 118(3): 1207-14[DOI][PubMed]
  • 6. Mangham LJ, Petrou S, Doyle LW, Draper ES, Marlow N. The cost of preterm birth throughout childhood in England and Wales. Pediatrics. 2009; 123(2)-27[DOI][PubMed]
  • 7. Romero R, Espinoza J, Kusanovic JP, Gotsch F, Hassan S, Erez O, et al. The preterm parturition syndrome. BJOG. 2006; 113 Suppl 3: 17-42[DOI][PubMed]
  • 8. Simmons LE, Rubens CE, Darmstadt GL, Gravett MG. Preventing preterm birth and neonatal mortality: exploring the epidemiology, causes, and interventions. Semin Perinatol. 2010; 34(6): 408-15[DOI][PubMed]
  • 9. Sayres WJ. Preterm labor. Am Fam Physician. 2010; 81(4): 477-84[PubMed]
  • 10. Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000; 342(20): 1500-7[DOI][PubMed]
  • 11. Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science. 2014; 345(6198): 760-5[DOI][PubMed]
  • 12. Elovitz MA, Saunders T, Ascher-Landsberg J, Phillippe M. Effects of thrombin on myometrial contractions in vitro and in vivo. Am J Obstet Gynecol. 2000; 183(4): 799-804[DOI][PubMed]
  • 13. Han CS, Schatz F, Lockwood CJ. Abruption-associated prematurity. Clin Perinatol. 2011; 38(3): 407-21[DOI][PubMed]
  • 14. Shynlova O, Tsui P, Jaffer S, Lye SJ. Integration of endocrine and mechanical signals in the regulation of myometrial functions during pregnancy and labour. Eur J Obstet Gynecol Reprod Biol. 2009; 144 Suppl 1-10[DOI][PubMed]
  • 15. Tan H, Yi L, Rote NS, Hurd WW, Mesiano S. Progesterone receptor-A and -B have opposite effects on proinflammatory gene expression in human myometrial cells: implications for progesterone actions in human pregnancy and parturition. J Clin Endocrinol Metab. 2012; 97(5)-30[DOI][PubMed]
  • 16. Mahendroo M. Cervical remodeling in term and preterm birth: insights from an animal model. Reproduction. 2012; 143(4): 429-38[DOI][PubMed]
  • 17. Snegovskikh V, Park JS, Norwitz ER. Endocrinology of parturition. Endocrinol Metab Clin North Am. 2006; 35(1): 173-91[DOI][PubMed]
  • 18. Strauss J3. Extracellular matrix dynamics and fetal membrane rupture. Reprod Sci. 2013; 20(2): 140-53[DOI][PubMed]
  • 19. Challis JRG, Matthews SG, Gibb W, Lye SJ. Endocrine and paracrine regulation of birth at term and preterm. Endocr Rev. 2000; 21(5): 514-50[DOI][PubMed]
  • 20. Romero R, Nicolaides KH, Conde-Agudelo A, O'Brien JM, Cetingoz E, Da Fonseca E, et al. Vaginal progesterone decreases preterm birth </= 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study. Ultrasound Obstet Gynecol. 2016; 48(3): 308-17[DOI][PubMed]
  • 21. Thorp JJ, Dole N, Herring AH, McDonald TL, Eucker B, Savitz DA, et al. Alteration in vaginal microflora, douching prior to pregnancy, and preterm birth. Paediatr Perinat Epidemiol. 2008; 22(6): 530-7[DOI][PubMed]
  • 22. Iams JD, Romero R, Culhane JF, Goldenberg RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet. 2008; 371(9607): 164-75[DOI][PubMed]
  • 23. Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hirsch P, et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ. 2016; 354[DOI][PubMed]
  • 24. McCarthy FP, Khashan AS, North RA, Rahma MB, Walker JJ, Baker PN, et al. Pregnancy loss managed by cervical dilatation and curettage increases the risk of spontaneous preterm birth. Hum Reprod. 2013; 28(12): 3197-206[DOI][PubMed]
  • 25. Donovan BM, Spracklen CN, Schweizer ML, Ryckman KK, Saftlas AF. Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis. BJOG. 2016; 123(8): 1289-99[DOI][PubMed]
  • 26. Sharp AN, Alfirevic Z. Provision and practice of specialist preterm labour clinics: a UK survey of practice. BJOG. 2014; 121(4): 417-21[DOI][PubMed]
  • 27. Ross GN, Ridout AE, Shennan AH. Promising recent advances in preterm birth management. FWH. 2016; 1: 27-33
  • 28. Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstet Gynecol. 2005; 106(1): 181-9[DOI][PubMed]
  • 29. Owen J, Yost N, Berghella V, Thom E, Swain M, Dildy G3, et al. Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA. 2001; 286(11): 1340-8[DOI][PubMed]
  • 30. Whitworth M, Quenby S, Cockerill RO, Dowswell T. Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes. Cochrane Database Syst Rev. 2011; (9)[DOI][PubMed]
  • 31. Kuhrt K, Smout E, Hezelgrave N, Seed PT, Carter J, Shennan AH. Development and validation of a tool incorporating cervical length and quantitative fetal fibronectin to predict spontaneous preterm birth in asymptomatic high-risk women. Ultrasound Obstet Gynecol. 2016; 47(1): 104-9[DOI][PubMed]
  • 32. Min J, Watson HA, Hezelgrave NL, Seed PT, Shennan AH. Ability of a preterm surveillance clinic to triage risk of preterm birth: a prospective cohort study. Ultrasound Obstet Gynecol. 2016; 48(1): 38-42[DOI][PubMed]
  • 33. Lee HJ, Park TC, Norwitz ER. Management of pregnancies with cervical shortening: a very short cervix is a very big problem. Rev Obstet Gynecol. 2009; 2(2): 107-15[PubMed]
  • 34. Grimes-Dennis J, Berghella V. Cervical length and prediction of preterm delivery. Curr Opin Obstet Gynecol. 2007; 19(2): 191-5[DOI][PubMed]
  • 35. Iams JD, Johnson FF, Sonek J, Sachs L, Gebauer C, Samuels P. Cervical competence as a continuum: a study of ultrasonographic cervical length and obstetric performance. Am J Obstet Gynecol. 1995; 172(4 Pt 1): 1097-103[DOI][PubMed]
  • 36. Groom KM, Bennett PR, Golara M, Thalon A, Shennan AH. Elective cervical cerclage versus serial ultrasound surveillance of cervical length in a population at high risk for preterm delivery. Eur J Obstet Gynecol Reprod Biol. 2004; 112(2): 158-61[DOI][PubMed]
  • 37. Honest H, Forbes CA, Duree KH, Norman G, Duffy SB, Tsourapas A, et al. Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling. Health Technol Assess. 2009; 13(43): 1-627[DOI][PubMed]
  • 38. Honest H, Bachmann LM, Gupta JK, Kleijnen J, Khan KS. Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review. BMJ. 2002; 325(7359): 301[DOI][PubMed]
  • 39. Berghella V, Hayes E, Visintine J, Baxter JK. Fetal fibronectin testing for reducing the risk of preterm birth. Cochrane Database Syst Rev. 2008; (4)[DOI][PubMed]
  • 40. Hezelgrave NL, Abbott DS, Radford SK, Seed PT, Girling JC, Filmer J, et al. Quantitative Fetal Fibronectin at 18 Weeks of Gestation to Predict Preterm Birth in Asymptomatic High-Risk Women. Obstet Gynecol. 2016; 127(2): 255-63[DOI][PubMed]
  • 41. Abbott DS, Hezelgrave NL, Seed PT, Norman JE, David AL, Bennett PR, et al. Quantitative fetal fibronectin to predict preterm birth in asymptomatic women at high risk. Obstet Gynecol. 2015; 125(5): 1168-76[DOI][PubMed]
  • 42. Goepfert AR, Goldenberg RL, Mercer B, Iams J, Meis P, Moawad A, et al. The preterm prediction study: quantitative fetal fibronectin values and the prediction of spontaneous preterm birth. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 2000; 183(6): 1480-3[PubMed]
  • 43. McLaren JS, Hezelgrave NL, Ayubi H, Seed PT, Shennan AH. Prediction of spontaneous preterm birth using quantitative fetal fibronectin after recent sexual intercourse. Am J Obstet Gynecol. 2015; 212(1): 89 e1-5[DOI][PubMed]
  • 44. Shennan A, Jones G, Hawken J, Crawshaw S, Judah J, Senior V, et al. Fetal fibronectin test predicts delivery before 30 weeks of gestation in high risk women, but increases anxiety. BJOG. 2005; 112(3): 293-8[DOI][PubMed]
  • 45. Simcox R, Seed PT, Bennett P, Teoh TG, Poston L, Shennan AH. A randomized controlled trial of cervical scanning vs history to determine cerclage in women at high risk of preterm birth (CIRCLE trial). Am J Obstet Gynecol. 2009; 200(6): 623 e1-6[DOI][PubMed]
  • 46. Hezelgrave NL, Duckworth S, Seed P, Shennan AH. Can fetal fibronectin testing and cervical length measurement direct appropriate prophylactic steroid use in high-risk, asymptomatic women? Arch Dis Child Fetal Neonatal Ed. 2011; 96: 55[DOI]
  • 47. Khambay H, Bolt LA, Chandiramani M, De Greeff A, Filmer JE, Shennan AH. The Actim Partus test to predict pre-term birth in asymptomatic high-risk women. J Obstet Gynaecol. 2012; 32(2): 132-4[DOI][PubMed]
  • 48. Conde-Agudelo A, Romero R. Cervical phosphorylated insulin-like growth factor binding protein-1 test for the prediction of preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016; 214(1): 57-73[DOI][PubMed]
  • 49. Ting HS, Chin PS, Yeo GS, Kwek K. Comparison of bedside test kits for prediction of preterm delivery: phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1) test and fetal fibronectin test. Ann Acad Med Singapore. 2007; 36(6): 399-402[PubMed]
  • 50. Cooper S, Lange I, Wood S, Tang S, Miller L, Ross S. Diagnostic accuracy of rapid phIGFBP-I assay for predicting preterm labor in symptomatic patients. J Perinatol. 2012; 32(6): 460-5[DOI][PubMed]
  • 51. Corabian P. The Actim Partus versus the TLI-IQ System as rapid response tests to aid in diagnosing preterm labour in symptomatic women 2008;
  • 52. Lee SM, Romero R, Park JW, Kim SM, Park CW, Korzeniewski SJ, et al. The clinical significance of a positive Amnisure test in women with preterm labor and intact membranes. J Matern Fetal Neonatal Med. 2012; 25(9): 1690-8[DOI][PubMed]
  • 53. Nikolova T, Bayev O, Nikolova N, Di Renzo GC. Evaluation of a novel placental alpha microglobulin-1 (PAMG-1) test to predict spontaneous preterm delivery. J Perinat Med. 2014; 42(4): 473-7[DOI][PubMed]
  • 54. Nikolova T, Bayev O, Nikolova N, Di Renzo GC. Comparison of a novel test for placental alpha microglobulin-1 with fetal fibronectin and cervical length measurement for the prediction of imminent spontaneous preterm delivery in patients with threatened preterm labor. J Perinat Med. 2015; 43(4): 395-402[DOI][PubMed]
  • 55. Khalil A. Partosure as a screening marker for spontaneous preterm birth.
  • 56. Newnham JP, Dickinson JE, Hart RJ, Pennell CE, Arrese CA, Keelan JA. Strategies to prevent preterm birth. Front Immunol. 2014; 5: 584[DOI][PubMed]
  • 57. Alfirevic Z, Stampalija T, Roberts D, Jorgensen AL. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev. 2012; (4)[DOI][PubMed]
  • 58. Shennan A. Cervical Cerclage. Cervical Cerclage. Royal College of Obstetricians & Gynaecologists 2011;
  • 59. Owen J, Hankins G, Iams JD, Berghella V, Sheffield JS, Perez-Delboy A, et al. Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol. 2009; 201(4): 375 e1-8[DOI][PubMed]
  • 60. Daskalakis G, Papantoniou N, Mesogitis S, Antsaklis A. Management of cervical insufficiency and bulging fetal membranes. Obstet Gynecol. 2006; 107(2 Pt 1): 221-6[DOI][PubMed]
  • 61. Simcox R, Shennan A. Reinforcing cerclage in the prevention of preterm birth in women at high risk: a retrospective case-controlled study. Aust N Z J Obstet Gynaecol. 2012; 52(3): 224-8[DOI][PubMed]
  • 62. Lotgering FK, Gaugler-Senden IP, Lotgering SF, Wallenburg HC. Outcome after transabdominal cervicoisthmic cerclage. Obstet Gynecol. 2006; 107(4): 779-84[DOI][PubMed]
  • 63. Carter J, Chandiramani M, Seed P, Shennan AH. The MAVRIC Consortium. MAVRIC: multicentre abdominal vs vaginal randomised investigation of cerclage. BJOG. 2015; 122: 1-7
  • 64. Dodd JM, Jones L, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database Syst Rev. 2013; (7)[DOI][PubMed]
  • 65. Norman JE, Marlow N, Messow CM, Shennan A, Bennett PR, Thornton S, et al. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet. 2016; 387(10033): 2106-16[DOI][PubMed]
  • 66. Preterm labour and birth. NICE 2015;
  • 67. Arabin B, Alfirevic Z. Cervical pessaries for prevention of spontaneous preterm birth: past, present and future. Ultrasound Obstet Gynecol. 2013; 42(4): 390-9[DOI][PubMed]
  • 68. Cannie MM, Dobrescu O, Gucciardo L, Strizek B, Ziane S, Sakkas E, et al. Arabin cervical pessary in women at high risk of preterm birth: a magnetic resonance imaging observational follow-up study. Ultrasound Obstet Gynecol. 2013; 42(4): 426-33[DOI][PubMed]
  • 69. Goya M, Pratcorona L, Merced C, Rodo C, Valle L, Romero A, et al. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet. 2012; 379(9828): 1800-6[DOI][PubMed]
  • 70. Hui SY, Chor CM, Lau TK, Lao TT, Leung TY. Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20 to 24 weeks: a randomized controlled trial. Am J Perinatol. 2013; 30(4): 283-8[DOI][PubMed]
  • 71. Hezelgrave NL, Watson HA, Ridout A, Diab F, Seed PT, Chin-Smith E, et al. Rationale and design of SuPPoRT: a multi-centre randomised controlled trial to compare three treatments: cervical cerclage, cervical pessary and vaginal progesterone, for the prevention of preterm birth in women who develop a short cervix. BMC Pregnancy Childbirth. 2016; 16(1): 358[DOI][PubMed]
  • 72. Brocklehurst P, Gordon A, Heatley E, Milan SJ. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. 2013; (1)[DOI][PubMed]
  • 73. King J, Flenady V. Prophylactic antibiotics for inhibiting preterm labour with intact membranes. Cochrane Database Syst Rev. 2002; (4)[DOI][PubMed]
  • 74. Shennan A, Crawshaw S, Briley A, Hawken J, Seed P, Jones G, et al. A randomised controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. BJOG. 2006; 113(1): 65-74[DOI][PubMed]
  • 75. Tebes CC, Lynch C, Sinnott J. The effect of treating bacterial vaginosis on preterm labor. Infect Dis Obstet Gynecol. 2003; 11(2): 123-9[DOI][PubMed]
  • 76. Bahl R, Gülmezoglu AM, Manu A, Mathai M, Oladapo O, von Xylander S. WHO recommendations on interventions to improve preterm birth outcomes 2015;
  • 77. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006; (3)[DOI][PubMed]
  • 78. Freeman CI, Hezelgrave NL, Shennan AH. Antenatal steroids for fetal lung maturity: Time to target more frequent doses to fewer women? Obstet Med. 2015; 8(4): 172-6[DOI][PubMed]
  • 79. Carter J, Tribe RM, Watson H, Shennan AH. Threatened preterm labour management: results following a 3rd round of a Delphi consensus. 2nd Annual Preterm Birth Research Conference. 2016;
  • 80. Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2009; (1)[DOI][PubMed]
  • 81. Haas DM, Benjamin T, Sawyer R, Quinney SK. Short-term tocolytics for preterm delivery - current perspectives. Int J Womens Health. 2014; 6: 343-9[DOI][PubMed]
  • 82. Malouf R, Redshaw M. Specialist antenatal clinics for women at high risk of preterm birth: a systematic review of qualitative and quantitative research. BMC Pregnancy Childbirth. 2017; 17(1): 51[DOI][PubMed]
  • 83. Chappell LC, Calderwood C, Kenyon S, Draper ES, Knight M. Understanding patterns in maternity care in the NHS and getting it right. BMJ. 2013; 346[DOI][PubMed]
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