All pregnant women should be assessed for risk of pre-term labor at the initial visit.  Risk status may be documented in the prenatal record.  At the first prenatal visit an obstetric history should be obtained.  If the patient has a history of preterm delivery then a referral to the high risk clinic is indicated to determine eligibility for 17-alpha hydroxyprogesterone therapy.  At each subsequent visit, the patient should be assessed for any symptoms of pre-term labor with appropriate documentation and referral if indicated. 

 

Recommendations:       

 

1.               With initial and subsequent assessments for pre-term labor, instructions along with appropriate educational material will be provided to each patient.

 

2.               Patients at risk for preterm labor should have an individualized plan of care which includes consultation with the medical provider.  The plan should be documented in the prenatal record.  Patients with a history of preterm delivery and/or one or more 2^nd trimester losses should receive consultation with a Duke physician and an Ultrasound as early in the current pregnancy as possible.

 

3.               Any patient that presents with symptoms suspicious for preterm labor/delivery should first undergo a speculum exam in order for the provider to obtain a Fetal Fibronectin sample, before a digital exam is performed. The FFN sample should be sent with the patient when she is referred to DUMC triage area for further evaluation.

 

 

Note:  The clinic may choose to use a preterm assessment tool other than the state preterm or risk assessment form.  The state will continue to make the preterm labor form available.  Clinic policies and procedures should clearly define the methods/tools used for preterm labor assessment

                                                        

                                                         Prepared in conjunction with the

Division of Maternal-Fetal Medicine

Duke University Medical Center

 

 

 

                                                                                                                                  Director

 

 

                                                                                                                                  Date

 

 

 

                                                                

 

 

Preterm Labor Assessment

1.     Alexander S, Blondel B, Boutsen M, Buekens P. EC collaborative study on      repeated vaginal examinations (REVE) during pregnancy.  Evaluation in pre-, peri, and post-natal care delivery systems 1992; 11-39.

 

 

2.     McDuffie RS, Nelson GE, Osborn CL, Crawmer SM, Orleans M, Haverkamp AD. Effect of routine weekly cervical examinations at term on premature rupture of the membranes:  a randomized control trial.  Obstet Gynecol. 1992; 79:219-222.

 

 

3.     MeisPJ, Klebanoff M, Thom E, Dombrowski MP, Sibai B, Moawad AH, et al.

     Prevention of recurrent preterm delivery by 17 alpha-hydroxprogesterone

     Caproate.  N Engl J Med 2003;348: 2379-85.                                    

 

 

 

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.