In the Literature: Intermountain Healthcare’s recurrent preterm birth consultation clinic is associated with improved care, outcomes

This project was selected from among many reported in the peer reviewed literature. For a list of more articles on quality improvement, visit our resource bibliography.

Article Citation

Manuck TA, Henry E, Gibson J, Varner MW, Porter TF, Jackson GM, Esplin MS, Pregnancy outcomes in a recurrent preterm birth prevention clinic, American Journal of Obstetrics and Gynecology, 2011, [Epub ahead of print]. [abstract]

Name of Agency/Organization/Institution

17 Utah hospitals within the Intermountain Healthcare System

Project Aims and Goals

Intermountain Healthcare established a recurrent preterm birth prevention clinic in an effort to provide consistent, evidence-based medical care and education to women who have already experienced at least one prior spontaneous preterm birth and are at high risk for recurrent preterm birth.

Approach and Activities

Intermountain Healthcare established a recurrent preterm birth (PTB) clinic in 2008 to provide standard consultative services to women with prior spontaneous PTB. Eligible women are referred by their primary obstetric care provider to the clinic, where they receive three prescribed visits, at 10-18 weeks’, 19-24 weeks’, and 28-32 weeks’ gestation, with additional visits as clinically indicated and remaining care provided in the usual setting. A standard protocol is followed that includes:

  • screening and treatment as needed for bacterial vaginosis, urinary tract infections, and other infections; ultrasound assessments of cervical length
  • counseling as to the woman’s personal recurrence risk and availability of progesterone (17OHPC) prophylaxis
  • treatment with cervical cerclage, modified bed rest, indomethacin, and betamethasone as indicated for selected patients exhibiting signs of preterm labor or shortened cervix.

Results

In a retrospective cohort study comparing eligible women who were referred to the recurrent PTB prevention clinic (n=70) with those who received usual care (n=153), recurrent PTB prevention clinic patients had increased utilization of resources, had lower rates of recurrent spontaneous PTB (48.6% vs 63.4%), delivered later (mean 36.1 vs 34.9 weeks), and had lower rates of composite major neonatal morbidity (5.7% vs 16.3%).

Blueprint Area(s) Addressed

Strategies used

Filed in Blueprint, Care coordination, Clinical practice guideline/policy change, In the Literature, New care delivery model, Progress, Staffing/care coordination change on Tue., May 3, 2011

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