Message from the chair: Preterm Labor Assessment Toolkit

Dr. Laurie C. GreggLaurie C. Gregg, MD

In a hospital with 40 ob-gyn providers, there can be 40 different ways to triage a patient presenting with preterm contractions. The variation in the assessment of preterm contractions, which has been documented in scientific publications, can lead to avoidable adverse outcomes and unnecessary interruption to a pregnant patient’s normal life.

More than 75% of patients presenting with preterm contractions deliver at term, yet 25% of preterm neonates do not receive antenatal corticosteroids. Some very low birth weight babies deliver at a facility unable to care for them.

Hospitals in California have the opportunity to improve the triage of these patients by implementing standardized preterm labor assessments. The Preterm Labor Assessment Toolkit (PLAT), initially developed at Sutter Medical Center, Sacramento, and published by the March of Dimes, is supported by the ACOG Committee on Obstetric Practice and complements the ACOG Practice Bulletin “Management of Preterm Labor” by providing algorithms and order sets for a hospital triage area. In addition to improving outcomes of preterm neonates and appropriately discharging pregnant patients who are low-risk for preterm labor, most hospitals that use the toolkit see cost savings as door-to-discharge time is four hours or less.

Before I began using this assessment tool, I often kept patients with preterm uterine contractions for evaluation for hours or days and had them back in the office frequently. I also would have two to three calls and one visit to the triage area to assess a preterm patient with contractions. Now, with the standardized protocols, many times one call to discuss results of the assessment and disposition is all it takes. The toolkit helps give moms and babies better outcomes in less time. Why wouldn’t hospitals implement PLAT? PLAT makes good sense, both practically and scientifically.

District IX will assist in the dissemination of PLAT information and hospital implementation through regional training sessions and at hospitals that request a speaker. Be on the lookout for more information. You should be able to request a speaker at the beginning of April.

Encourage your labor and delivery triage area to implement PLAT. You and the moms and babies of California will benefit.