Utilizing new evidence in the prevention of recurrent preterm birth

Abstract

Objective: Treatments that have proven to be effective in large randomized controlled trials are implemented in clinical practice at varying rates. We measured to what extent new and established strategies were applied to prevent recurrent preterm birth in the Netherlands. Methods: In two academic hospitals, two non-academic teaching hospitals and two non-academic, non-teaching hospitals, we reviewed charts of all women who had delivered in 2006 and at that time had a history of spontaneous preterm birth before 34 weeks. We compared the application of preventive treatments between different types of hospitals. Results: Ninety-one records were identified. In academic centers, screening for bacterial vaginosis and progesterone treatment were applied more often than in other centers (49 vs. 14%, p-value 0.001 and 63 vs. 22%, p-value <0.001, respectively). Cervical length measurement was applied more often in non-academic hospitals (58 vs. 39%, p-value 0.07), but with fewer measurements per patient (average of 3.3 vs. 5.8). Conclusion: In the management of women with a history of preterm birth, there is large practice variation. Relatively new treatments such as progesterone injections and screening for bacterial vaginosis are applied more frequently in academic centers, whereas cervical length measurement is more often performed in non-academic hospitals.

Keywords::

• Cerclage
• cervical length
• evidence-based medicine
• prematurity
• progesterone

Acknowledgements

The authors would like to thank Dr. Dijkman, BovenIJ Hospital Amsterdam, Dr. Bernardus, Tergooi Hospitals Blaricum, Prof. Dr. van Lith, Onze Lieve Vrouwe Gasthuis Amsterdam and Dr. Porath, Máxima Medical Centre Veldhoven, for their cooperation in providing patient data.

Declaration of interest: The authors report no conflicts of interest.