Wake Forest Preterm Birth Prevention Clinic: Is PTB a Modifiable Risk Factor with a Standardized Approach?
ACOG ePoster. Quinn K. Apr 27, 2018; 211529
Kristen Quinn
Kristen Quinn
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Abstract
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Introduction: Risk of recurrent spontaneous PTB is 15-30% and 50% for women who have delivered ≥2 babies prior to 32 weeks. Women with inadequate access to care are at risk for PTB. We hypothesized standardized management in a designated prevention clinic would reduce risk of PTB in high risk women.


Methods: Retrospective cohort study evaluating pregnancies at risk for PTB. Women were managed with a standardized protocol of surveillance and medical/surgical interventions under care of a consistent team in a designated preterm birth prevention clinic. Patients' recurrence risk of PTB was calculated adjusting for race, number of prior PTB, and gestational age of prior PTB. Calculated recurrence risk was compared to outcomes when followed in our clinic. Compliance with prenatal visits and reason for delivery were tracked. Univariate and multivariate analyses were used where appropriate.


Results: 188 women with PTB history were enrolled and had complete data. Mean calculated recurrence risk of PTB was 42.6% (SD 25.9; 16-100). 87.3% were compliant with all scheduled appointments. Mean GA at delivery 36.3 weeks. Calculated risk score for PTB at enrollment was not predictive of PTB after care in our clinic (R=0.017). Enrollment in our prematurity clinic significantly reduced the risk of PTB from predicted (42.6% to 24.5%, p=0.0002, OR 0.44; 95% CI 0.28-0.68).


Conclusion/Implications: Enrollment in our prematurity clinic significantly decreased the risk of PTB from predicted. In our high risk population only 8% delivered
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