Clinical guidelines for prevention and management of preterm birth: a systematic review
Abstract
Background: Clinical practice guidelines ( CPG ) endorse multiple strategies to prevent or manage preterm birth ( PTB ). Objectives: To summarise CPG recommendations for PTB and identify areas of international consensus. Search strategy: In May 2017 we searched for all CPG relevant to PTB without language restrictions. Selection criteria: CPG were eligible if the following criteria were met: (1) the guideline was published or current from June 2013; (2) the guideline recommended practices for the prevention or management of PTB relevant to our prespecified clinical questions for screening, medications or surgery and other interventions; (3) publications on methods of guideline development for eligible CPG were included to enable quality assessment. Data collection and analysis: Two authors classified CPG recommendations relevant to prespecified clinical questions. When more than 70% of CPG s reporting on a topic recommended or rejected an intervention, we regarded this as consensus. We summarised recommendations in tables. Main results: We identified 49 guidelines from 16 guideline developers. We found consensus for several clinical practices: cervical length screening for high‐risk women; short‐term tocolysis; steroids for fetal lung maturation; and magnesium sulphate for fetal neuroprotection. We found discrepant recommendations for progesterone and fibronectin. No guideline identified an effective strategy for women with multiple pregnancy. Conclusions: We identified interventions for which there is an international consensus on benefit for PTB . Systematic reviews of CPG using standardised methodology will help avoid duplication and target scarce resources for guideline developers globally. Tweetable abstract: International clinical guidelines agree on the benefits and harmful effects of several important interventions to prevent preterm birth.
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Several medical societies recommend serial transvaginal sonographic CL measurement at 16-23 weeks in women with singleton gestation, a short cervix and prior spontaneous preterm birth.
“Several medical societies recommend serial transvaginal sonographic CL measurement at 16-23 weeks in this population 104,105,108,109 .”
From <scp>ISUOG</scp> Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan (2022) · cites this paper as [108]
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- Authors
- Medley, N., Poljak, B., Mammarella, S., & Alfirevic, Z.
- Affiliations
- University of Liverpool (GB)
- Royal Victoria Infirmary (GB)
- Department of Women's and Children's Health University of Liverpool Liverpool Women's Hospital Liverpool UK
- Corresponding author
- Medley, N
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2018-03-25
- Volume
- 125
- Issue
- 11
- Pages
- 1361-1369
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2790939872
- Cited by
- 108
- References
- 40
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 24 · 2023: 18 · 2022: 14 · 2021: 19 · 2020: 7 · 2019: 7 · 2018: 7
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Liverpool
- Topics
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- preterm birth, preterm birth prevention, guideline recommendations, international consensus, cervical length screening, tocolysis, magnesium sulfate, progesterone, fibronectin, multiple pregnancy, guideline quality assessment
- MeSH terms
- Female, Humans, Magnesium Sulfate, Pregnancy, Prenatal Care, Steroids, Tocolysis, Practice Guidelines as Topic, Premature Birth, Cervical Length Measurement
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