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Prediction and prevention of preterm birth: Quality assessment and systematic review of clinical practice guidelines

Aparna Ramachandran1,2, Klorkor D Clottey3, Adrienne Gordon1,2,4

  • 1Faculty of Medicine and Health, University of Sydney, Sydney, Australia.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|April 15, 2024
PubMed

Insights

Predicting preterm birth (PTB) risk with clinical practice guidelines (CPGs) shows consensus on risk factors and prevention strategies like progesterone. Areas for future research include PTB clinics and biomarkers.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Evidence-Based Medicine

Background:

  • Predicting pregnancies at risk of preterm birth (PTB) is crucial for implementing targeted prevention strategies.
  • Current clinical practice guidelines (CPGs) offer a framework for PTB prediction and prevention.

Purpose of the Study:

  • To evaluate the quality of existing CPGs for spontaneous PTB prediction and prevention.
  • To identify areas of consensus and disagreement within these guidelines.

Main Methods:

  • A comprehensive search for CPGs on PTB prediction and prevention in asymptomatic singleton pregnancies was conducted in January 2024.
  • CPGs published between July 2017 and December 2023 were assessed for quality using the AGREE-II tool.
  • Recommendations were extracted and categorized by prediction and prevention domains for general and high-risk populations.

Main Results:

  • Thirty-seven CPGs from 20 organizations were included, all demonstrating moderate to high overall quality.
  • Consensus exists on predicting PTB through risk factor identification and cervical length screening in high-risk pregnancies.
  • Agreed-upon prevention strategies include universal screening for asymptomatic bacteriuria, BV screening/treatment in high-risk pregnancies, and the use of progesterone and cerclage.

Conclusions:

  • This review highlights the strengths and limitations of current CPGs for PTB management.
  • Areas requiring further investigation include the role of PTB clinics, universal cervical length measurement, biomarkers, and cervical pessaries.
Abstract

Keywords:
clinical practice guidelinepredictionpremature birthpreterm birthpreventionsystematic review

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