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ObstetricianGynecologists Screening and Management of Preterm Birth

Morgan, Maria A. PhD1; Goldenberg, Robert L. MD2; Schulkin, Jay PhD1

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31817c50fc
Original Research
Abstract

OBJECTIVE: To define obstetrician–gynecologists’ screening for potential preterm birth risk factors and interventions they use when indicators suggest the patient may be at increased risk.

METHODS: Questionnaires were mailed to 1,193 American College of Obstetricians and Gynecologists members.

RESULTS: The response rate was 59%. Respondents most frequently report screening for previous preterm birth (98%) and cone biopsy (95%) as risk factors for preterm birth. Twenty-one percent do not screen for asymptomatic urinary tract infection and 57% screen for group B streptococci in an attempt to prevent preterm birth. Almost one third (31%) routinely recommend bed rest in twin pregnancies. Most (98%) use tocolytics (primarily magnesium sulfate, 94%) for women with intact membranes in preterm labor. Nearly 100% use corticosteroids in anticipated preterm births, and few (4%) repeat the dosing if delivery has not occurred within 1 week. Twenty-four percent of respondents did not have access to a newborn intensive care unit (ICU); they were more likely to refer a patient with an impending preterm delivery to a maternal–fetal medicine specialist for complete care than were those with a newborn ICU available (79% compared with 9%; P<.001).

CONCLUSION: Most obstetrician–gynecologists are practicing in accord with current findings on preterm birth risk factors and interventions. However, there may be overscreening and underscreening for various infections and overuse of bed rest as a preterm birth intervention. When preterm birth is imminent, physicians often and appropriately seek the most specialized care possible for their patients.

LEVEL OF EVIDENCE: III

In Brief

Obstetrician&amp;#x2013;gynecologists are practicing primarily in accord with current findings on preterm birth and are appropriately seeking the most specialized care when preterm delivery is imminent.

Author Information

From the 1American College of Obstetricians and Gynecologists, Washington, District of Columbia; and 2Drexel University College of Medicine, Philadelphia, Pennsylvania.

See related article on page 42.

Supported by Grant #R60 MC 05674 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.

Corresponding author: Maria A. Morgan, PhD, Research Department, American College of Obstetricians and Gynecologists, 409 12th Street, SW, Washington, DC, 20024; e-mail: mmorgan@acog.org.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 The American College of Obstetricians and Gynecologists