A significant number of woman who delivered ahead of term and were already considered at risk for spontaneous preterm birth did not receive any sort of intervention to prevent the preterm birth, according to Yu Yang Feng and associates.
For the retrospective study, the researchers analyzed the medical records of 31 women who had been admitted to a primary, secondary, or tertiary prenatal care center and who had a history of spontaneous singleton preterm birth and/or cervical shortening before 24 weeks of gestation. Of the 23 women who were referred to a prenatal care center before reaching a gestational age of 24 weeks, only 13 were offered an intervention and only 12 received progesterone or cerclage as an intervention, while none received pessary. One of the 13 was offered and declined progesterone.
Of the 12 women who received an intervention before 24 weeks’ gestational age, 8 received progesterone, 2 received elective cerclage, and 2 received rescue cerclage. An additional woman who was referred to a prenatal care center after 24 weeks received progesterone, the only one in that group to receive an intervention.
Most of the women in the study were referred to a prenatal care center by their family physician, although two were referred by their midwife, one was referred by a nurse practitioner and fertility specialist, and three started their care with an obstetrician.
“Our findings that less than one in three women with a previous preterm birth or current short cervix received progesterone attest to the importance of improving knowledge translation with the latest evidence to encourage referral in time and use of this intervention for the prevention of preterm birth,” the study investigators concluded.
Find the full study in the Journal of Obstetrics and Gynaecology Canada (2018 Jan. doi: 10.1016/j.jogc.2017.08.036).