Obstetrician-gynecologists' screening and management of preterm birth.

Abstract

To define obstetrician-gynecologists' screening for potential preterm birth risk factors and interventions they use when indicators suggest the patient may be at increased risk. Questionnaires were mailed to 1,193 American College of Obstetricians and Gynecologists members. The response rate was 59%. Respondents most frequently report screening for previous preterm birth (98%) and cone biopsy (95%) as risk factors for preterm birth. Twenty-one percent do not screen for asymptomatic urinary tract infection and 57% screen for group B streptococci in an attempt to prevent preterm birth. Almost one third (31%) routinely recommend bed rest in twin pregnancies. Most (98%) use tocolytics (primarily magnesium sulfate, 94%) for women with intact membranes in preterm labor. Nearly 100% use corticosteroids in anticipated preterm births, and few (4%) repeat the dosing if delivery has not occurred within 1 week. Twenty-four percent of respondents did not have access to a newborn intensive care unit (ICU); they were more likely to refer a patient with an impending preterm delivery to a maternal-fetal medicine specialist for complete care than were those with a newborn ICU available (79% compared with 9%; P<.001). Most obstetrician-gynecologists are practicing in accord with current findings on preterm birth risk factors and interventions. However, there may be overscreening and underscreening for various infections and overuse of bed rest as a preterm birth intervention. When preterm birth is imminent, physicians often and appropriately seek the most specialized care possible for their patients. III.