A simple ultrasound scan could determine whether a woman in her first pregnancy needs a cheap hormone treatment to prevent her baby from being born too early. Preterm birth—before 37 weeks—affects one in ten babies worldwide and is the leading cause of death in the first month of life. Most preterm births happen in women considered low-risk, especially those in their first pregnancy, and rates are higher among Black and Asian women, teenagers, and those living in deprived areas. Current NHS screening only targets women with known risk factors, missing the majority of cases. This four-year programme tests whether offering cervical length screening and progesterone treatment to all first-time mothers is practical, acceptable to women and clinicians, and cost-effective for the NHS. If successful, the UK National Screening Committee could recommend national adoption, potentially reducing preterm birth rates and narrowing stark health inequalities. The researchers will also train sonographers to deliver consistent, high-quality scans and assess the psychological impact of a short-cervix diagnosis on women.
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Research questions: Is it possible to design and implement a cervical length screening and progesterone treatment pathway for all women in their first pregnancy? Is it cost effective in an NHS setting? Background: Preterm birth (PTB), birth before 37 weeks gestation, affects 1 in 10 babies worldwide. It is the leading cause of death in the first 28 days as well as under 5 years of age, is associated with lifelong disabilities and is very costly for NHS, families and society . Cervical length scann (CLS), and progesterone treatment if the cervix is short, is currently offered to women considered to be high risk for PTB. However, most preterm births occur in women thought to be low-risk particularly in nulliparous women in whom pregnancy risks are not yet known. PTB is also more common in black and Asian women, teenagers and those with higher levels of deprivation. Reducing PTB and these inequalities is a priority. Aims and objectives: To assess the feasibility of designing and implementing a screen and treat pathway for nulliparae in the NHS to: 1. Evaluate acceptability of the pathway to Health Care Professionals and providers; 2. Evaluate acceptability of the pathway to women and the psychological impact of diagnosing a short cervix; 3. Evaluate health economic aspects of offering CLS and treatment; 4. Confirm that high quality, standardised cervical length scan training can be delivered; 5. Define a pathway for CLS, treatment and follow-up; 6. Evaluate incidence, intervention and outcomes from incidental findings at transvaginal scan; 7. Implement this screening pathway. Methods: We have worked with the UK National Screening Committee (UKNSC) Research and Methodology Group to design a mixed-methods programme with 5 work-packages (WPs). These evaluate the proposed pathway. WP1 and WP2: interviews and focus groups to assess the acceptability to healthcare professionals/providers (WP1) and women (WP2). WP2 will also include an assessment of the psychological impact on women. WP3: model the cost effectiveness and assessment of its feasibility and validity by sensitivity analyses. WP4: pathway development: through provision of high quality CLS training and quality assurance of images; reporting the incidence and assessing the impact of incidental findings at CLS; defining a screening pathway; conducting an implantation study in 15 maternity centres; WP5: national adoption through stakeholder engagement. Timelines for delivery: this is a 4-year programme. WP1 months 0-18 WP2 months 0-24 WP3 months 0-48 WP4 months 0-42 WP5 months 42-48 Anticipated impact and dissemination: If successful, this programme will lead to the UKNSC recommending that the UK Governments adopt CLS screening for nulliparous women. This would be possible through the new UKNSC mechanism of implementation as an in-service evaluation, which this programme would fulfil. WP results will also be disseminated through our patient and public/charity partners (Tommys/SANDS/BLISS) and national organisations (RCOG/RCM/Fetal Medicine Foundation/British Medical Ultrasound Society). This will include presentation and publication in peer-reviewed journals.
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