Opinion regarding the care of women at risk of preterm birth varies considerably within published literature and international guidelines. We wished to see whether this heterogeneity was reflected in UK practice, despite national guidance regarding screening of such women and use of progesterone prophylaxis.Methods
A survey was circulated via the BMFMS mailing list. Additional direct contact was made with clinicians in working in areas with a low response rate to secure wider geographic coverage.Results
The overall response rate was 16.4% (82/500), representing 66 units throughout the UK. Practice indeed varies considerably: many clinicians follow RCOG guidance regarding the screening of high risk women, but often deviate to provide individualised care. Only 27% of respondents worked in a unit with a dedicated preterm labour clinic. 52% of clinicians surveyed choose not to follow UK guidance regarding the use of supplementary progesterone and prescribe it outside the context of research trials for selected patients. These clinicians generally expressed the opinion that there was strong evidence to recommend progesterone therapy in select groups. 86% of clinicians using progesterone prescribed cyclogest pessaries/suppositories, though route, dose and frequency of administration varied. A minority of respondents used injectable progestins (4%).Conclusions
There is a disparity between UK guidance and the opinion of many obstetricians surveyed here. Whilst the small sample size limits our conclusions, the merits of progesterone therapy warrant further consideration, informed by rapidly emerging research evidence which will be expected to drive a review of national guidance.