title: Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes.
abstract: BACKGROUND
  Amongst the risk factors for preterm birth, previous preterm delivery is a strong predictor. Specialised clinics for women with a history of spontaneous preterm delivery have been advocated as a way of improving outcomes for women and their infants.
  
  
  OBJECTIVE
  To assess using the best available evidence, the value of specialised antenatal clinics for women with a pregnancy at high risk of preterm delivery when compared with 'standard' antenatal clinics.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2011).
  
  
  METHODS
  All published, unpublished, and ongoing randomised controlled trials (including cluster-randomised trials) examining specialised compared with standard antenatal clinic care for women with a singleton pregnancy considered at high risk of preterm labour.
  
  
  METHODS
  Two review authors independently assessed trial quality and extracted data.
  
  
  RESULTS
  We included three trials with 3400 women, all carried out in the USA. All focused on specialised clinics for women at high risk of preterm birth. Gestational age at delivery, preterm delivery, or both were primary outcomes in all studies. The interventions in the three trials differed.Overall there was very little data on our prespecified outcomes. For most outcomes a single study provided data, hence there was not the statistical power to detect any possible differences between groups. There was no clear evidence that specialised antenatal clinics reduce the number of preterm births.
  
  
  CONCLUSIONS
  Specialised antenatal clinics are now an accepted part of care in many settings, and carrying out further randomised trials may not be possible. Any future research in this area should include psychological outcomes and should focus on which aspects of service provision are preferred by women. Such research could underpin further service development in this area.
authors: St Mary's Hospital, Central Manchester and Manchester Children's University Hospitals NHS Trust, Hathersage Road, Manchester, UK, M13 0JH.
authors: Melissa
authors: M
authors: Whitworth
authors: Siobhan
authors: S
authors: Quenby
authors: Ruth O
authors: RO
authors: Cockerill
authors: Therese
authors: T
authors: Dowswell
mesh_terms: D005260:Female; D006801:Humans; D010353:Patient Education as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000175:diagnosis / Q000517:prevention & control*; D011295:Prenatal Care / Q000458:organization & administration / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention