Schlembach D, Simeoni U, Nagy Bonnard L, Bernloehr A, Cetin I, Gente M, Grosek S, Johnston L, Jourdain G, Kainer, Ratnavel N, Rossi R, Roth-Kleiner M, Visser G
Healthcare professionals caring for women, perinatal units, hospitals, and health services
Statement of standard
All (pregnant) women receive timely information and counselling about potential risk factors for and signs and symptoms of preterm birth and how to find appropriate healthcare advice. (see Follow-up & continuing care)
Rationale
Risk identification and education regarding the signs and symptoms of preterm birth are essential components of obstetric care. They should be a routine part of obstetric care, since counselling of women and their partners and early intervention may be effective in reducing the risk of preterm birth. Healthcare providers (be it a midwife, general practitioner or an obstetrician/gynaecologist) should be able to advise and appropriately triage patients at risk for preterm birth. (1–10)
Differentiation between low risk and high risk pregnancies is important to assess the best strategy of preventing preterm birth or managing women at risk. Specific standards of care should be applied to women with known risk factors for preterm birth. Early detection and provision of specialist care may reduce the incidence of preterm birth and the associated fetal/neonatal and maternal complications. (1–10). Although for the majority of preterm births the cause may be uncertain, there are specific risk constellations that women and healthcare professionals should be aware of.
Criteria/risk factors for preterm birth include pregnancy related factors, demographic and behavioural factors, underlying medical conditions of the mother and fetal conditions (detailed information see table at “description”). (1–10)
Benefits
Short-term benefits
Better informed women and partners (6,11–14,17,20–24)
Improved pregnancy follow-up (4,11,15,17,20,21)
Earlier recognition of impending complications (4,11,15,19–21)
Earlier transfer/referral to a specialist (4,11,15,17,19–21)
Better and earlier initiation of prophylactic or therapeutic regimens (4,11,15,17–21)
Reduced perinatal mortality and morbidity (12,15–21,24)
Reduced maternal mortality and morbidity (12,17–19,23,24)
Reduced healthcare costs (12,17)
Long-term benefits
Improved short- and long-term outcomes (mother and infant/child) (consensus)
Reduced healthcare costs (consensus)
Increased population awareness about pregnancy complications (consensus)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
(Pregnant) women are informed by healthcare professionals about risk factors and also symptoms and/or signs for impending pregnancy complications. (13,14,20–24)
A (High quality) B (High quality)
Patient information sheet1
Accurate communication (all essential information) is provided. (13,14)
A (High quality) B (High quality)
Parent feedback
For healthcare professionals
Training on the risks and signs of preterm birth and tools for assessment of risk for impending preterm birth is attended by all responsible healthcare professionals. (25–30)
A (High quality) B (High quality)
Training documentation
Professional and empathic communication is provided. (13,14)
A (High quality) B (High quality)
Healthcare professional feedback, parent feedback
Women at risk for very preterm birth are cared for exclusively in specialist centres. (31–33)
A (High quality) B (High quality)
Audit report2
For perinatal unit
A unit guideline on procedures and algorithms for the management of threatened preterm birth and underlying conditions is available and regularly updated. (34)
A (High quality) B (High quality)
Guideline
Women at risk for very preterm birth are referred and transferred to appropriate delivery clinic in a timely fashion. (31–33)
A (High quality) B (High quality)
Audit report2
For hospital
Training on the risks and signs of preterm birth and tools for assessment of risk for impending preterm birth is ensured.
B (High quality)
Training documentation
Continuous quality improvement programme is in place. (35)
A (High quality) B (Moderate quality)
Audit report2
For health service
A national guideline on procedures and algorithms for the management of threatened preterm birth and underlying conditions is available and regularly updated.
B (High quality)
Guideline
Regional networks for perinatal care are established. (36)
A (High quality)
Regional network
Risk reduction programmes are in place.
B (Moderate quality)
Audit report2
An appropriate working environment for pregnant women is provided by employers. (37)
C (High quality)
Workplace legislation
1The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator ‘audit report” can also be defined as a benchmarking report.
Where to go
Further development
Grading of evidence
For parents and family
Advocate for enhanced maternity and paternity leave benefits.
B (High quality)
For healthcare professionals
N/A
For perinatal unit
N/A
For hospital
N/A
For health service
Encourage or promote increase in funding of research on the causes and prevention of preterm birth.
B (Moderate quality)
Getting started
Initial steps
For parents and family
Parents are verbally informed in a timely manner on healthy pregnancy and pregnancy complications by healthcare professionals.
For healthcare professionals
Attend training on the risks and signs of preterm birth and tools for assessment of risk for impending preterm birth and pregnancy complications.
Counsel women/couples (e.g. by midwives, general practitioners, obstetricians/gynaecologists).
For perinatal unit
Develop and implement a unit guideline on procedures and algorithms for the management of threatened preterm birth and underlying conditions.
Distribute information material on healthy pregnancy and pregnancy complications for parents.
For hospital
Support healthcare professionals to participate in training on the risks and signs of preterm birth and tools for assessment of risk for impending preterm birth.
For health service
Develop and implement a national guideline on procedures and algorithms for the management of threatened preterm birth and underlying conditions.
Develop information material on healthy pregnancy and pregnancy complications for parents.
Risk factors for preterm birth (3–10)
Pregnancy related conditions
Reproductive history: history of (spontaneous) preterm birth or abortion
Preterm labour: may be caused by several conditions: multiples, hydramnios, infection, …
Multiple pregnancy
Pregnancy complications: Gestational diabetes, hypertensive disorders (preeclampsia), intrauterine growth restriction, vaginal bleeding in early pregnancy, cervical insufficiency
Assisted reproduction techniques: higher number of multiples and increased risk of pregnancy complications
Age: particularly young (<17 years) or older women (>35 years)
Ethnicity: higher risk for preterm birth in black women
Socioeconomic background: low education level, low income, little social support does play a role for preterm birth
Genetic influence: Specific fetal and maternal genotypes
Modifiable lifestyle risk factors
Short inter-pregnancy interval
Smoking or substance abuse
Exposure to environmental pollutants
Under- and overweight (obesity)
Unbalanced diet
High stress level
Suboptimal prenatal care
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