Main findings
The introduction of a multifaceted PTB prevention initiative was associated with a significant 10% reduction in the overall rate of PTB compared to the average for the previous 5 years at the main tertiary referral hospital in the ACT. Rates of PTB after the introduction of the initiative were lower than any of the preceding 5 years. These findings were consistent with the successful results from the WA experience.2, 19 Once PTBs were separated in to grouped gestational ages the greatest reduction in preterm birth were observed in the 20-23+6 and 28-31+6 gestation age groups. Non-significant reductions were found for the 24-27+6 gestational age group, however, there was a slight increase in this group 32-36 weeks. The run chart data shows that the majority of the effect appears to occur soon after the implementation of the initiative in early 2019, most likely due to increased awareness and momentum from the initiative. This highlights the need for sustained outreach education for health professionals and the community.
Rates of iatrogenic early term births with NMI were significantly reduced by 34.5% (12.33% from 18.84%) and this was sustained over the whole year of the post intervention period. This highlights the success of the hospital’s policy encouraging judicious decision making for early term births and the receptiveness by staff to this change. We have included early term births in this analysis as we believe interventions aimed at reducing rates early term births should be considered alongside preterm birth prevention strategies due to the emerging research on the adverse effects of the early term birth. We hypothesise that the overall increase in early term births is due to a delay in preterm births, shifting the distribution curve to the right.
This study focussed on the effect of early birth in singleton pregnancies for two main reasons. We aimed to offer consistency in the literature by assessing singleton births similar to the previous study in Western Australia. We are also aware the mechanism for pre term birth in singletons and multiples may vary and the majority of the interventions in this initiative were focussed on singleton pregnancies.
The economic impact of averted or delayed early births is an important aspect that is outside of the scope of this study but would be the basis of valuable follow up research. With the resource rich, and expensive neonatal intensive care bed spaces costing in excess of $1000 per day to run 20, the reduction of these bed numbers would have significant fiscal benefits.