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Carlisle N, Care A, Anumba DOC, Dalkin S, Sandall J, Shennan AH. How are hospitals in England caring for women at risk of preterm birth in 2021? The influence of national guidance on preterm birth care in England: a national questionnaire. BMC Pregnancy Childbirth 2023; 23:47. [PMID: 36670432 PMCID: PMC9854090 DOI: 10.1186/s12884-023-05388-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND National guidance (Saving Babies Lives Care Bundle Version 2 (SBLCBv2) Element 5) was published in 2019, with the aim to standardise preterm care in England. We plan to identify how many preterm birth surveillance clinics there are in England, and to define current national management in caring for women who are both asymptomatic and high-risk of preterm birth, and who arrive symptomatically in threatened preterm labour, to assist preterm management both nationally and internationally. METHODS An online survey comprising of 27 questions was sent to all maternity units in England between February 2021 to July 2021. RESULTS Data was obtained from 96 units. Quantitative analysis and free text analysis was then undertaken. We identified 78 preterm birth surveillance clinics in England, an increase from 30 preterm clinics in 2017. This is a staggering 160% increase in 4 years. SBLCBv2 has had a considerable impact in increasing preterm birth surveillance clinic services, with the majority (61%) of sites reporting that the NHS England publication influenced their unit in setting up their clinic. Variations exist at every step of the preterm pathway, such as deciding which risk factors warrant referral, distinguishing within particular risk factors, and offering screening tests and treatment options. CONCLUSIONS While variations in care still do persist, hospitals have done well to increase preterm surveillance clinics, under the difficult circumstances of the COVID pandemic and many without specific additional funding.
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Affiliation(s)
- Naomi Carlisle
- grid.13097.3c0000 0001 2322 6764Department of Women and Children’s Health, The School of Life Course & Population Sciences, King’s College London, 10th Floor North Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Angharad Care
- grid.415996.60000 0004 0400 683XCentre for Women and Children’s Health Research, University of Liverpool, Liverpool Women’s Hospital, Liverpool, UK
| | - Dilly O. C. Anumba
- grid.11835.3e0000 0004 1936 9262Academic Unit of Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Sonia Dalkin
- grid.42629.3b0000000121965555Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Jane Sandall
- grid.13097.3c0000 0001 2322 6764Department of Women and Children’s Health, The School of Life Course & Population Sciences, King’s College London, 10th Floor North Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Andrew H. Shennan
- grid.13097.3c0000 0001 2322 6764Department of Women and Children’s Health, The School of Life Course & Population Sciences, King’s College London, 10th Floor North Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
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Next generation strategies for preventing preterm birth. Adv Drug Deliv Rev 2021; 174:190-209. [PMID: 33895215 DOI: 10.1016/j.addr.2021.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/22/2022]
Abstract
Preterm birth (PTB) is defined as delivery before 37 weeks of gestation. Globally, 15 million infants are born prematurely, putting these children at an increased risk of mortality and lifelong health challenges. Currently in the U.S., there is only one FDA approved therapy for the prevention of preterm birth. Makena is an intramuscular progestin injection given to women who have experienced a premature delivery in the past. Recently, however, Makena failed a confirmatory trial, resulting the Center for Drug Evaluation and Research's (CDER) recommendation for the FDA to withdrawal Makena's approval. This recommendation would leave clinicians with no therapeutic options for preventing PTB. Here, we outline recent interdisciplinary efforts involving physicians, pharmacologists, biologists, chemists, and engineers to understand risk factors associated with PTB, to define mechanisms that contribute to PTB, and to develop next generation therapies for preventing PTB. These advances have the potential to better identify women at risk for PTB, prevent the onset of premature labor, and, ultimately, save infant lives.
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Carlisle N, Watson HA, Kuhrt K, Carter J, Seed PT, Tribe RM, Sandall J, Shennan AH. Ten women's decision-making experiences in threatened preterm labour: Qualitative findings from the EQUIPTT trial. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100611. [PMID: 33882392 DOI: 10.1016/j.srhc.2021.100611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/15/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical triage of women in threatened preterm labour (TPTL) could be improved through utilising the QUiPP App, as symptoms alone are poor predictors of early delivery. As most women in TPTL ultimately deliver at term, they must weigh this likelihood with their own personal considerations, and responsibilities. The importance of personal considerations was highlighted by the 2015 Montgomery ruling, and the significance of shared decision-making. AIMS Through qualitative interviews, the primary aim was to explore women's decision-making experiences in TPTL through onset of symptoms, triage, clinical assessment, and discharge. METHODS Qualitative interviews were undertaken as part of the EQUIPTT study (REC: 17/LO/1802) using a semi-structured interview schedule. Descriptive labels of the coding scheme were applied to the raw transcript data. This coding scheme was then increasingly refined into key themes and allowed parallels to be made within and between cases. RESULTS Ten ethnically diverse women who presented at six different London hospitals sites in TPTL were interviewed. Three final themes emerged from the data incorporating 10 sub-themes, 'Seeking help', 'Being "assessed" vs making clinical decisions together', and 'End result.' CONCLUSION Women described their busy lives and the need to juggle their commitments. Participants drew comparisons between their TPTL symptoms and 'period pain,' contrasting to typical medical terminology. Shared decision-making and the clinician-patient relationship could be improved through clinicians utilizing terminology women understand and relate to. Women used language that highlighted the clinician-patient power balance. While not fully involved in shared decision-making, women were overall satisfied with their care.
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Affiliation(s)
- N Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom.
| | - H A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - K Kuhrt
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - P T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - R M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - J Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
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