Implementation protocol for a treatment bundle targeting modifiable risk factors for preterm birth

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Maternal-Fetal Medicine

Background:

• Preterm birth (PTB) is a leading cause of neonatal mortality globally.
• Current PTB prevention strategies are not widely implemented, especially in high-prevalence areas.
• Effective management of modifiable risk factors is crucial for reducing adverse pregnancy outcomes.

Purpose of the Study:

• To implement a simple, low-cost intervention bundle for identifying and managing major modifiable risk factors for PTB.
• To assess the feasibility and impact of this protocol in a high-prevalence setting in Jaú - SP, Brazil.
• To reduce the incidence of PTB through proactive risk factor management.

Main Methods:

• Inclusion of first-trimester pregnant women in Brazil with high PTB rates.
• Utilized a questionnaire for smoking status and clinical history.
• Incorporated Gram staining for vaginal microbiota assessment (Nugent's criteria) and cervical infection screening.
• Transvaginal ultrasound to measure cervical length.

Main Results:

• Pregnant smokers received auricular acupuncture and support group referrals.
• Patients with vaginal dysbiosis received treatment and hygiene advice.
• Women diagnosed with cervical shortening were treated with vaginal progesterone.
• The study demonstrated the importance of active PTB risk factor management in high-risk populations.

Conclusions:

• A simple, low-cost intervention bundle can effectively address modifiable PTB risk factors.
• Early identification and management of smoking, vaginal infections, and cervical length are vital.
• Implementing such protocols in high-prevalence settings can significantly impact maternal and neonatal outcomes.