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Should Case Management Be Considered as a Component of Obstetric Interventions for Pregnancies at Risk for Preterm Birth?"

  • Thomas J. Garite
    Correspondence
    Corresponding author: Thomas J. Garite, M.D.Sera Prognostics, Inc.2749 East Parleys Way Salt Lake City UT 81409
    Affiliations
    Sera Prognostics, Salt Lake City, Utah, United States; University of California Irvine, Orange, CA, USA
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  • Tracy A. Manuck
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina 27599, United States

    Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
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Open AccessPublished:September 18, 2022DOI:https://doi.org/10.1016/j.ajog.2022.09.022
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      Abstract

      Preterm birth remains the leading cause of morbidity and mortality among non-anomalous neonates in the United States. Unfortunately, rates of preterm birth remain high despite current medical interventions such as progestogen supplementation and cerclage placement. Case management, which encompasses coordinated care aimed at providing a more comprehensive and supportive environment, is a key component in improving health and reducing costs in other areas of medicine but largely has not made its way into the lexicon and practice of obstetric care. Case management intended for decreasing prematurity or ameliorating its consequences may include specialty clinics, social services, coordination of specialty services such as nutrition counseling, home visits or frequent phone calls by specially trained personnel, and other elements described herein. It is not currently included in, nor is it advocated for as a recommended prematurity prevention approach in American College of Obstetricians and Gynecologists or Society for Maternal-Fetal Medicine guidelines for medically indicated or spontaneous preterm birth prevention. Our review of existing evidence finds consistent reductions or trends towards reductions in preterm birth with case management, particularly among individuals with high a priori risk of preterm birth, across systematic reviews, meta-analyses, and randomized controlled studies. These findings suggest that case management has substantial potential to improve the environmental, behavioral, social, and psychologic factors in patients at risk for preterm birth.

      Keywords