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Screening for preterm labour

Presentation by Dr Heather Payne

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Public Health England hosts the UK National Screening Committee
Preterm Labour and
Bacterial Vaginosis
Screening in Pregnancy
Heather Payne
Commissioning the review
• Combined existing recommendations on
Bacterial Vaginosis and Preterm Labour
• Review commissioned by UK NSC in 2013
and undertaken by Bazian
Document Development
• Review took in literature between January 2007
and May 2013
• Focus for screening test section of the review on
ultrasonographic cervical length measurement
• Review shared with both the Fetal Maternal and
Child Health subgroup (FMCH) and UK NSC in
July 2014 and following comments, approval
was given to open consultation
Findings - The Condition
• Confirmed preterm labour to be a serious condition with
short and long-term consequences
• While bacterial vaginosis is generally not serious it can
occasionally lead to complications in pregnancy such as
preterm labour
• 6.3% (34,925) of live singleton births > 24 < 36 weeks’
gestation in England (2011-12).
• However….it is unclear how many of these premature
births were to low-risk women
• Aims of screening still unclear (prevent <37 week births
or <34w).
Findings – The Test
• For BV, evidence on BV as a predictor of
preterm labour is limited
• Measurement of cervical length in asymptomatic
women is not reliable enough for use as a
screening tool.
• Therefore, it is not known whether the test is
reliable in identifying which pregnancies are at
risk and which are not
Findings – The Treatment
• No agreement on the effectiveness of antibiotics
for BV
• Insufficient evidence that vaginal progesterone is
effective at preventing preterm labour
• Insufficient evidence that vaginal progesterone
reduces the most severe outcomes (death or
disability) for the baby
Ad

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Screening for preterm labour

  • 1. Public Health England hosts the UK National Screening Committee Preterm Labour and Bacterial Vaginosis Screening in Pregnancy Heather Payne
  • 2. Commissioning the review • Combined existing recommendations on Bacterial Vaginosis and Preterm Labour • Review commissioned by UK NSC in 2013 and undertaken by Bazian
  • 3. Document Development • Review took in literature between January 2007 and May 2013 • Focus for screening test section of the review on ultrasonographic cervical length measurement • Review shared with both the Fetal Maternal and Child Health subgroup (FMCH) and UK NSC in July 2014 and following comments, approval was given to open consultation
  • 4. Findings - The Condition • Confirmed preterm labour to be a serious condition with short and long-term consequences • While bacterial vaginosis is generally not serious it can occasionally lead to complications in pregnancy such as preterm labour • 6.3% (34,925) of live singleton births > 24 < 36 weeks’ gestation in England (2011-12). • However….it is unclear how many of these premature births were to low-risk women • Aims of screening still unclear (prevent <37 week births or <34w).
  • 5. Findings – The Test • For BV, evidence on BV as a predictor of preterm labour is limited • Measurement of cervical length in asymptomatic women is not reliable enough for use as a screening tool. • Therefore, it is not known whether the test is reliable in identifying which pregnancies are at risk and which are not
  • 6. Findings – The Treatment • No agreement on the effectiveness of antibiotics for BV • Insufficient evidence that vaginal progesterone is effective at preventing preterm labour • Insufficient evidence that vaginal progesterone reduces the most severe outcomes (death or disability) for the baby
  • 7. Consultation with the public • Consultation between July and October 2014 • Consultation highlighted through • the UK NSC webpage • social media • PHE internal communications and • through e-mail contact with registered stakeholders • One consultation response • Feedback from RCOG agreed there was no indication for screening in the low risk population
  • 8. UK National Screening Committee • UK National Screening Committee considered the review and consultation comments at its November 2014 meeting • Committee recommended not to offer universal screening for for both Preterm Labour and Bacterial Vaginosis • Recommendation published in January 2015
  • 9. Key Questions for next review Both recommendations re-reviewed as part of the UK NSC 3 year review cycle. Future research should address: • What would screening aim to prevent? • What is the optimal cut-off and gestational age for cervical length screening? • Does cervical length or other measure fulfil HTA criteria for a useful test? • What is the optimal treatment strategy?
  • 10. Key Questions – Continued • Does a screen-and-treat strategy reduce preterm birth? • What are the consequences and acceptability issues arising from screening? • Are there large studies evaluating possible screening tests for preterm labour in asymptomatic women? such as: • cervicovaginal fetal fibronectin, • amniotic fluid CRP measurement and • uterine contractions (home uterine monitoring)