Main findings
The introduction of a multifaceted PTB prevention initiative was
associated with a significant 10% reduction in the overall rate of PTB
compared to the average for the previous 5 years at the main tertiary
referral hospital in the ACT. Rates of PTB after the introduction of the
initiative were lower than any of the preceding 5 years. These findings
were consistent with the successful results from the WA experience.2, 19 Once PTBs were separated in to grouped
gestational ages the greatest reduction in preterm birth were observed
in the 20-23+6 and 28-31+6 gestation age groups. Non-significant
reductions were found for the 24-27+6 gestational age group, however,
there was a slight increase in this group 32-36 weeks. The run chart
data shows that the majority of the effect appears to occur soon after
the implementation of the initiative in early 2019, most likely due to
increased awareness and momentum from the initiative. This highlights
the need for sustained outreach education for health professionals and
the community.
Rates of iatrogenic early term births with NMI were significantly
reduced by 34.5% (12.33% from 18.84%) and this was sustained over the
whole year of the post intervention period. This highlights the success
of the hospital’s policy encouraging judicious decision making for early
term births and the receptiveness by staff to this change. We have
included early term births in this analysis as we believe interventions
aimed at reducing rates early term births should be considered alongside
preterm birth prevention strategies due to the emerging research on the
adverse effects of the early term birth. We hypothesise that the overall
increase in early term births is due to a delay in preterm births,
shifting the distribution curve to the right.
This study focussed on the effect of early birth in singleton
pregnancies for two main reasons. We aimed to offer consistency in the
literature by assessing singleton births similar to the previous study
in Western Australia. We are also aware the mechanism for pre term birth
in singletons and multiples may vary and the majority of the
interventions in this initiative were focussed on singleton pregnancies.
The economic impact of averted or delayed early births is an important
aspect that is outside of the scope of this study but would be the basis
of valuable follow up research. With the resource rich, and expensive
neonatal intensive care bed spaces costing in excess of $1000 per day
to run 20, the reduction of these bed numbers would
have significant fiscal benefits.