Should case management be considered a component of obstetrical interventions for pregnancies at risk of preterm birth? - 30/03/23
, Tracy A. Manuck, MD c, dAbstract |
Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates in the United States. Unfortunately, preterm birth rates 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. However, it has not made its way into the general lexicon and practice of obstetrical 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 the 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 toward reductions in preterm birth with case management, particularly among individuals with high a priori risk of preterm birth across systematic reviews, metaanalyses, and randomized controlled studies. These findings suggest that case management has substantial potential to improve the environmental, behavioral, social, and psychological factors with patients at risk of preterm birth.
Le texte complet de cet article est disponible en PDF.Key words : case management, case managers, nutrition counseling, prematurity education, preterm birth, psychosocial support, smoking cessation, substance abuse counseling
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| T.J.G. is employed by and owns stock options in Sera Prognostics, Inc, which makes PreTRM—a blood test for assessing the risk of preterm delivery. He is also a consultant for Perigen, Inc, a company that sells labor and delivery software to assess fetal heart rate and other data for patients in labor and delivery. |
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| T.A.M. was funded in part by grant #R01-MD011609 from the National Institute on Minority Health and Health Disparities, National Institutes of Health. |
Vol 228 - N° 4
P. 430-437 - avril 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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