SMFM Preterm Birth Toolkit

Preterm birth (PTB) is the main cause of perinatal morbidity and mortality in most countries. It is generally defined as a birth between 20 0/7 and 36 6/7 weeks of gestation. In the United States, the 2014 data showed that PTB occurs in 9.5% of births, or almost 500,000 births. The aim of this Society for Maternal-Fetal Medicine (SMFM) document is to supply clinical providers with easy-to-use practice algorithms and other materials to better implement clinical screening and interventions to prevent PTB, and especially to prevent the burden of PTB, i.e. decrease perinatal morbidity and mortality related to PTB. The toolkit is not intended to dictate a certain management or course of action and users are encouraged to adapt them to their particular situation, environment and patient population.

What is a toolkit and How to use it:

Toolkits, triggers, bundles, protocols, and checklists are examples of tools that can be used directly by the clinician to facilitate improvements in quality of care and to lead to improvements in outcomes. A bundle is usually defined as a set of evidence-based best practices, that when implemented, are designed to achieve optimal patient outcomes. This initiative is defined as a ‘toolkit,’ to adjust for the fact that while there was an effort to present only evidenced-based suggestions for care, the evidence for some of these suggestions is limited, or somewhat controversial. There is recognition that currently we do most of the right things for most of the patients most of the time, and our goal is to reliably do all of the right things, for all of the patients all of the time. This toolkit is not meant to mandate exclusive ways of managing certain conditions or clinical situations. This is an effort to help standardize care so that all members of the team can work better together, and can come closer to achieving this ideal. Within a toolkit are tools designed to assess barriers and to assist execution to improve care in a wide variety of clinical settings.  These materials are designed to strike a balance between standardization and clinical discretion.  

SMFM guidance on preterm birth:

• Clinical Guideline, Progesterone and preterm birth prevention: translating clinical trials data into clinical practice
• Consult Series, When to use fetal fibronectin
• Consult Series, Cervical cerclage for the woman with prior adverse pregnancy outcome
• Consult Series, Patient counseling following periviable premature rupture of the membranes
• Consult Series #40, The role of routine cervical length screening in selected high-and low-risk women for preterm birth prevention
• SMFM Statement, Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery