Introduction
PTB is defined as birth before 37 completed weeks of pregnancy and is associated with a range of adverse outcomes.1-4 It is considered one of the most significant causes of perinatal morbidity and mortality worldwide.5,6 Every year an estimated 15 million babies are born preterm, with approximately 1 million deaths attributed to preterm complications.7 In 2018, 8.7% of Australian babies were born preterm, with the highest incidence in the Northern Territory (11.9%) and lowest in New South Wales (7.7%). Over the past 10 years there has been a small increase in the proportion of PTB across Australia (8.2% to 8.7%).8
There is growing evidence showing a proportion of spontaneous PTBs can be prevented.9,10 There exists substantial evidence showing the efficacy of individual interventions for the prevention of spontaneous early birth including cervical cerclage,11vaginal progesterone pessary supplementation12 and mid trimester ultrasound of the cervix.13 Reducing these early births can result in significant health, social and economic impacts for families and significant economic benefits for health services.14, 15 The importance of preventing early term births is also emerging. Research suggests that there can be adverse short- and long-term health effects for those born early term (37-38+6 weeks) compared to late term (39 weeks onwards), especially in the domains of neonatal admissions, respiratory distress and neurodevelopment.16,17 Data shows that planned early term births are increasing across Australia and the beneficial effects of lengthening pregnancy is not often emphasised in clinical practice.8,18
A team in Western Australia (WA) implemented a comprehensive state-wide PTB prevention initiative in 2014, incorporating a range of interventions aimed at reducing early births across the state. One year after implementation of the program there was a significant reduction in the incidence of PTB, with 7.6% reduction in singleton PTBs statewide and 20.3% at the main tertiary level referral hospital. This WA study was the first of its kind in assessing integrated PTB prevention strategies across a population.2
Following WA success, the Centenary Hospital for Women and Children (CHWC) in the ACT introduced the ACT PTB prevention initiative in 2019. The aim of the initiative was to safely lower the rate of early births, following the WA model. The objective of this study was to evaluate the ACT PTB prevention initiative and its effects on PTBs and early term births at the main tertiary hospital and to assess whether the initiative achieved similar results in the ACT context.