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.