A retrospective service evaluation of pregnancy management and outcomes in women attending the North Bristol Trust Preterm Prevention Clinic
The aim of this service evaluation was to assess pregnancy outcomes for women referred to and attending the North Bristol NHS Trust (NBT) Preterm Birth Prevention Clinic (PTBPC). Pregnancies were analysed according to reason for referral, gestational age at birth, number of preterm births, and whether progesterone and cervical cerclage (CC) were offered.
Women who had been referred to the PTBPC between 31st March 2020 and 31st December 2020 were identified using Lorenzo software. The following data regarding management of these pregnancies for each of these women was obtained from Viewpoint and from hospital notes available via the NBT Electronic Document Management System (EDMS): maternal age, smoking status, number of appointments per woman, gestation and cervical length measurement at each appointment, whether progesterone was offered/prescribed, whether CC was offered/performed, gestational age (GA) at birth, and mode of labour and birth. These data were analysed according to reason for referral.
Between 31st March and 31st December 2020, 323 appointments were scheduled for 107 women. The four most common indications for referral were: previous preterm birth (PPTB) (33 women), previous large loop excision of transformation zone (LLETZ) >10 cm (PLLETZ) (29 women), previous caesarean section at full dilatation (PCSFD) (23 women) and previous second trimester miscarriage (PSTM) (11 women). A further 11 women were referred for uterine anomaly or previous stillbirth.
Across the top four indications for referral, the median GA at birth were: PPTB 38+4 (range 31+2 – 40+3); PLLETZ 39+0 (range 32+2 – 41+2); PCSFD 39+2 (range 37+4 – 41+2); and PSTM 38+0 (35+4 – 40+5). Preterm birth (<37 weeks’) rates were 15% (5/33) for women referred with PPTB, 7% (2/29) for women referred with PLLETZ, 13% (3/23) for women referred with PCSFD, and 0% for women referred with PSTM. Eighteen percent (6/33) of those women with PPTB were prescribed progesterone, compared with none for the other three categories of referral indication; and 12% (4/33) women with PPTB, 7% (2/29) women with PLLETZ, 4% (1/23) women with PCSFD, and 0% of women with PSTM had a CC inserted. Reassuringly, all the women with CC in the PLLETZ and STM groups, and all but one woman in the PPTB group, birthed at term; with one woman who received both progesterone and CC in the PPTB group birthing preterm.
The results of this service evaluation indicate that women are being appropriately referred to and managed in the PTBPC at NBT, with most women birthing at term.