Prevention And Management Of Preterm Labor

-  Cervical Length Measurement

QS.1

Recommend routine cervical length measurement to women during the mid-trimester morphology (18–20 weeks) ultrasound scan with the cervical length documented in medical records

QM.1

Numerator: number of women who had cervical length measured and recorded in the mid-trimester morphology (18–20 weeks) ultrasound scan.

Denominator: total number of women who had the mid-trimester morphology (18–20 weeks) ultrasound scan.

 -   Vaginal Progesterone Prescription

QS.2

For singleton pregnancies recommend vaginal progesterone 200 mg by night from 16–36 weeks gestation for women with an incidentally diagnosed shortened cervix (less than or equal to 25 mm) on TVCL between 16–24 weeks.

QM.2

Numerator: number of women with an incidentally diagnosed shortened cervix (less than or equal to 25 mm) on TVCL between 16–24 weeks who were prescribed vaginal progesterone 200 mg by night from 16–36 weeks gestation.

Denominator: total number of women who were incidentally diagnosed with short cervix (less than or equal to 25 mm) on TVCL between 16–24 weeks.

-  Oral Erythromycin for PPROM

QS.3

Offer women with PPROM oral erythromycin 250 mg 4 times a day for a maximum of 10 days or until the woman is in established labor (whichever is sooner).

QM.3

Numerator: number of with PPROM who were prescribed oral erythromycin 250 mg 4 times a day for a maximum of 10 days or until the woman is in established labor (whichever is sooner).

Denominator: total number of women with PPROM.

-Identifying infection in women with PPROM

QS.4

Use a combination of clinical assessment and tests (C-reactive protein, white blood cell count and measurement of fetal heart rate) to diagnose intrauterine infection in women with PPROM every 48 hours. Do Not use any of these tests in isolation to confirm or exclude intrauterine infection.

QM.4

Numerator: number of women with PPROM who were assessed clinically and with C-reactive protein, white blood cell count and measurement of fetal heart rate to diagnose intrauterine infection in women with PPROM.

Denominator: total number of women with PPROM.

- Tocolysis for Diagnosed PTL

QS.5

Tocolysis is recommended to give time for a course of corticosteroid therapy or to allow in-utero transfer to an obstetric center with higher-level neonatal care.

QM.5

Numerator: number of women diagnosed with preterm labor who received tocolysis.

Denominator: total number of women diagnosed with preterm labor.

- Corticosteroids for Diagnosed PTL

QS.6

Corticosteroids are administered to women with diagnosed PTL according to ONE of the following protocols:

• Betamethasone: two 12-mg doses of betamethasone I.M. 24 hours apart

OR

• Dexamethasone: four 6-mg doses of dexamethasone I.M. at 12 hours intervals

QM.6

Numerator: number of women diagnosed with preterm labor who received corticosteroids according to the protocol

Denominator: total number of women diagnosed with preterm labor.