Methods:
The study was approved by the Human Research Ethics Committee in the ACT (reference number 2019/ETH12446; approved 17 July 2019). The intervention was the PTB prevention initiative and the main outcomes measured were rates of PTB and early term birth before and after implementation of the initiative.
The PTB prevention initiative was a multifaceted initiative. Initially a guideline on the prevention and management of PTB was developed and a three-month program of outreach education and dissemination of the new clinical guidelines took place with sonographers, obstetricians, midwives and general practitioners across the territory and surrounding southern New South Wales (NSW) areas. The initiative was officially launched on 28 February 2019 and received philanthropic support to establish the service and Ministerial endorsement.
The key interventions in the new clinical guidelines for the ACT were based on the WA initiative.
These included:
After the launch, further multidisciplinary education sessions were organised for sonographers, general practitioners, midwives and obstetricians throughout the ACT and hospitals in the southern NSW and Murrumbidgee districts.
The new PTB prevention clinic was established within the Fetal Medicine Unit (FMU) at CHWC. CHWC is the sole tertiary level centre for referral of high-risk pregnancies for the ACT and surrounding NSW areas. Thus, the initiative aimed to capture all women with an increased risk of PTB. Referrals were made through the FMU and were triaged as a priority. The clinic is staffed by an Obstetrician, a Fetal Medicine Fellow, a midwife, a sonologist and sonographers. Continuity of care was offered to all women or they could refer back to their original care provider once the early risk of PTB had passed.
A pre and post intervention study was conducted to examine the association between the PTB prevention initiative and preterm and early term birth rates. Our analysis included women who gave birth at the CHWC in the pre intervention period from 1 January 2014 to 31 December 2018 and the post intervention period from 1 January 2019 to 30 April 2020. Inclusion criteria included women who had a singleton birth between 20-39 weeks gestation within the study period. Rates of PTB and early term birth before (2014-2018) and after 16 months of implementation of the initiative were evaluated. Rates of early birth were assessed using run charts of bimonthly preterm and early term rates from 2014-2020. Run charts show patterns of change over time and can identify trends, runs and how an intervention is performing.
Data was collected from the Central Birth Outcome System electronic medical record. This system collects all births from 20 weeks of pregnancy at the CHWC. Retrospective collection of existing records occurred for both the pre intervention and post intervention groups. Data included demographic information, gestational age at birth, plurality, birth outcomes and whether births were spontaneous or iatrogenic. All data was de-identified and the study did not require patient involvement. Discrete data were reported as number and percent and compared using Chi Square tests. A p-value of 0.05 was considered significant.