UWNQC Preterm Birth Prevention Video Series



Angela Anderson, CNM, DNP and UWNQC Board Chair introduces the series and gives some basic information about Preterm Birth.
Utah Women and Newborns Quality Collaborative (UWNQC)

Data:

  • Utah’s 2015 Preterm Birth Rate: 9.30% (2014 = 9.1%, 2013=9.1%, 2012=9.1%, 2011=9.4%, 2010=9.5%)
  • The March of Dimes Prematurity Campaign’s goal is a prematurity rate of 8.1%, or less, by 2020.
Sean Esplin, MD and Medical Director speaks about Preterm Birth risk factors and gives information about 17 alpha hydroxy progesterone caproate (17P) and other progesterones.

UWNQC Maternal Subcommittee

Data:

  • Utah’s 2015 Preterm Birth Rate: 9.30%
  • Women who have had a previous preterm birth may have a risk as high as 30-40% of experiencing another preterm birth in a subsequent pregnancy
  • Women who are found to have a cervical length less than 2.5 cm are at significantly increased risk of subsequent preterm delivery
  • 15% of all preterm births that occur in the United States are born to women who have a previous history of a preterm birth. (Approximately 75,000 of the 500,000 preterm births that occur annually in the United States occur in women with a previous history who could be identified at the beginning of their pregnancy)
  • Interventions such as progesterone supplementation may reduce the rate of preterm birth by up to 30%. (This represents a reduction of 10,000 preterm births annually in the United States)
  • 1 meta-analysis of 7 randomized trials compared the use of 17 alpha hydroxy progesterone caproate or 17 P to the use of placebo in the same group of women. This study found reduction of 50% in the rate of preterm birth at less than 37 weeks gestation.

Sean Esplin, MD and Medical Director speaks about how to get patients their progesterone for prevention of preterm birth.

The 17 prescription should read:
  • 17-progesterone 250mg/ml. 1ml IM weekly, Duration 20 weeks, Start at 16 weeks gestation”. (Synonyms include “hydroxyprogesterone caproate” “17 alpha-hydroxy progesterone” and “17 hydroxy progesterone”)
Use ICD 10 code:
  • “O09.212, supervision of high risk pregnancy in the second trimester”
  • “O09.213, supervision of high risk pregnancy with history of preterm birth in the third trimester”
  • Or “O09.219, supervision of high risk pregnancy with history of preterm labor, unspecified trimester”

Data:

Helen Feltovich, MD talks about the role of cervical length measurement and cerclage for prevention of preterm birth.

Data:

  • Only about 1 in 4 women with a short cervix in the midtrimester will actually deliver preterm
  • Women who have both a history of preterm birth and a short cervix are at highest risk
Erin Clark, MD and Medical Director talks about the importance of counseling with patients postpartum.

Data:

  • Women who have had a previous preterm birth may have a risk as high as 30-40% of experiencing another preterm birth in a subsequent pregnancy
  • 15% of all preterm births that occur in the United States are born to women who have a previous history of a preterm birth. (Approximately 75,000 of the 500,000 preterm births that occur annually in the United States occur in women with a previous history who could be identified at the beginning of their pregnancy)

David Turok, MD talks about the role of family planning and speaking to patients about immediate postpartum (IPP) long-acting reversible contraception.

17 Steps for Immediate Postpartum IUD Insertion:

  1. Cleanse the vulva, vagina and cervix with hibaclens or betadine for disinfection.
  2. Use sterile gloves reduce infection risk.
  3. Place a clean drape underneath the buttocks and on the abdomen.
  4. Insert a speculum, retractor or gloved hand into the vagina and visualize the cervix.
  5. Prep the cervix and the vagina with a liberal application of an antiseptic solution, allow time for the antiseptic to work.
  6. Gently grasp the anterior lip of the cervix with ring forceps. (Do not use a toothed tenaculum because it may tear the cervix)
  7. Grasp the IUD with Kelly placental forceps or with a second pair of standard ring forceps. The IUD should be held by its vertical arm, the horizontal arm of the IUD should be slightly out of the ring in the same direction of the rings and slightly sided. This will facilitate the liberation of the IUD in the fundus, decreasing the risk of pulling it out will removing the forceps.
  8. Exert gentle traction towards you of the cervix-holding forceps.
  9. Insert the forceps holding the IUD through the cervix and into the lower uterine cavity. Avoid touching the walls of the vagina with the IUD.
  10. As the IUD passes through the cervix, release the hand that is holding the cervix-holding forceps and move this hand to the abdomen placing it over the uterine fundus.
  11. With the abdominal hand, stabilize the uterus with firm downward pressure through the abdominal wall. Prevent the uterus from moving upward in the abdomen as the IUD is inserted.
  12. Move the IUD-holding forceps IUD in an upward motion toward the fundus (in an angle towards the umbilicus). Remember that the lower uterine segment may be contracted and therefore some slight pressure may be necessary to advance the IUD and achieve fundal placement.
  13. If the client has delivered vaginally after a previous cesarean delivery, take care to avoid placing the IUD through any defect in the previous incision by maintaining your ring forceps pressured against the posterior uterine wall.
  14. By feeling the uterus through the relaxed abdominal wall, confirm with the abdominal hand that the tips of the forceps reach the fundus.
  15. Open the forceps, releasing the IUD.
  16. Slowly remove the forceps from the uterine cavity, keeping it slightly open, and sweeping the forceps slightly laterally to avoid entanglement with the string.
  17. Examine the cervix.

Data:

Resources:

UWNQC is working to provide 1.0 AMA PRA Category 1 Credits™ to providers for this video series; however, this is currently unavailable. If you are interested in receiving Credits, please contact uwnqc@utah.gov.


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MAILING ADDRESS:

Utah Women and Newborn Quality Collaborative (UWNQC)
PO Box 142002
Salt Lake City, UT 84114

Phone and Email:

Phone: 801-273-2856

Email: uwnqc@utah.gov