Clinical Summary for Preterm Labor Management

How the Program Works

Matria's Preterm Labor Management Program provides comprehensive obstetrical nursing care complemented by a full-time pharmacy staff experienced in obstetrics. Clinicians work with patients to help them improve self-care skills with the primary goal of preventing prenatal complications that lead to extremely preterm births.

Through daily telephone calls with patients and frequent clinical assessments, Matria's obstetrical nurses also electronically monitor uterine activity to identify abnormal contraction patterns and symptoms of preterm labor. Any significant changes in a patient's condition are reported to the patient's physician immediately, so that appropriate care and clinical interventions can be initiated, which may result in prolonging the pregnancy.

Matria offers the following in-home services related to preterm labor prevention/surveillance:

17 alpha-hydroxyprogesterone caproate therapy (17p)
Home uterine activity monitoring
Home uterine activity monitoring with tocolytic therapy
Subcutaneous tocolytic therapy

Matria's preterm labor program offers the following:

Experienced nurses to assist high-risk obstetrical nurses
24/7 nursing and pharmacy staff
Initial one-to-one comprehensive nursing education
Ongoing education to address patient needs and physician's treatment plan
Written patient education materials
Improved patient compliance
Surveillance of high-risk patients who require additional time and resources
Individual and aggregate outcome reports by payer and by provider

Facts You Need to Know

Preterm birth is the major cause of infant morbidity and mortality and creates a significant economic burden for families, health plans and employers. In the United States, almost $11 billion is spent annually for newborn medical care. Although approximately 12 percent of infants are born prematurely, care for these infants consumes almost 60 percent of total dollars spent on newborn care.

Overall, the cost of care for infants in neonatal intensive care units (NICUs) accounts for 75 percent of all dollars spent for newborn care. NICU care is often necessary for infants delivered prematurely with low birth weights of 2,500 grams or less or very low birth weights of 1,500 grams or less due to issues related to immature respiratory, neurologic or gastrointestinal systems.

Length of NICU admission and NICU costs are often inversely proportional to the gestational age at delivery. Based on a report by the U.S. Agency for Healthcare Research and Quality, medical costs for the average very low birth weight infant is $79,000 versus $1,000 for the average normal newborn.

A rise in twin and triplet deliveries, coupled with an increase in the number of women having children later in life, indirectly contributed to a 25 percent increase in preterm deliveries during the 1980s and 1990s, and the rates continue to climb ever higher.

PTL Outcomes

Matria showed substantial cost savings in an internal study of 32,557 patients with singleton and twin gestations using Matria’s pump and monitoring services from 1999 to 2003.

For every dollar spent on Matria’s homecare services, $3.30 was saved.
An average of $13,000 was saved per pregnancy, including the program cost.
Matria saved $156 million in antenatal hospital admissions.

Facts About Preterm Labor

Delivery is considered preterm when it occurs between 20 to 37 weeks. If the pregnancy ends prior to 20 weeks of gestation, it is considered a miscarriage or an abortion (spontaneous or therapeutic). Preterm labor is the most significant contributor to preterm birth and is diagnosed when both uterine contractions and cervical change occur between 20 and 37 weeks' gestation.

Clinical Presentation for Diagnosis of Preterm Labor

Changes in the cervix that indicate preterm labor are identified during a pelvic examination by a health care provider and include:

Softening or change in the consistency of the cervix
Effacement or thinning/shortening of the cervix
Dilation or opening of the cervix

Frequent contractions and dilation and/or effacement of the cervix increase the risk for preterm delivery. Preterm delivery may result in significant neonatal morbidity (illness) and mortality (death). Manifestations of morbidity may be short- or long-term in nature.

Treatment
Preterm labor is a multifaceted complication of pregnancy, accounting for the majority of pre-delivery hospitalizations. Decisions regarding treatment and management options can have a significant impact on clinical outcomes and costs of care. Matria supports physician management of patients experiencing preterm labor and those at risk for preterm delivery through programs providing home-based education, surveillance and clinical services.

Causes
The cause of preterm labor is not completely understood. Aside from a diagnosis of preterm labor in a current pregnancy, the following conditions may also be associated with an increased likelihood of preterm labor and delivery:

Previous preterm labor or delivery
Abnormally shaped uterus, uterine surgery, exposure to DES (a drug that may have been given to a patient's mother to prevent miscarriage)
Two or more second trimester abortions or miscarriages
Incompetent cervix, cone biopsy, large fibroids
Current pregnancy with twins, triplets, or more
Severe kidney and urinary tract infections
Cervical dilation or effacement before 36 weeks of pregnancy
Excessive uterine contractions before 36 weeks
Bleeding, placenta previa, too much or too little amniotic fluid
Age less than 18 or greater than 35
Unusual physical or mental stress

Recognizing Preterm Labor

At this time, preterm labor cannot be prevented. Therefore, the best approach is to identify it early and treat it effectively to help the pregnancy continue. Early recognition of the signs and symptoms of preterm labor may result in opportunities for successful intervention.

The following are symptoms that may be associated with preterm labor. However, they can also be a very normal part of a healthy pregnancy. These symptoms become problematic when they represent a change from an individual patient's normal pattern or experience.

Uterine contractions. The uterus (womb) is composed of muscle fibers. A uterine contraction is the tightening of the muscle within the uterus. Using your fingertips to feel the uterus, you should be able to indent your uterus when it is relaxed. During a contraction you feel your uterus tighten and become hard. Contractions occur normally throughout pregnancy. They are usually painless and they can occur at any time. Certain activities such as changing your position or having a full bladder may cause a contraction. The type of contraction you will have with preterm labor may also be painless, but there is often a pattern of tightenings. Your uterus will feel hard over the entire surface, and this tightening may occur every 15 minutes or closer. Each contraction may last from 40 seconds up to 1 1/2 to two minutes.
Menstrual-like cramps. These are felt low in the abdomen, just above the pubic bone. The cramping may be rhythmic, feeling like waves or fluttering. You may also feel constant cramping.
Lower, dull backache. This backache is located mainly in the lower back and may radiate to the sides or front. It may be rhythmic or constant, and often is not relieved by change of position.
Pelvic pressure. You may feel pressure of fullness in the pelvic area, in your back or your thighs. It may feel as though the baby is going to "fall out."
Intestinal cramps. These may occur in the presence or absence of diarrhea. You may have the feeling of "gas pains."
Increase or change in vaginal discharge. The amount may be more than that which is normal to you. The consistency may change to mucous or water. The color may become pink or brown-tinged.
Feeling that something is not right. Many women with preterm labor have a sense that things do not feel as they did before.

Risk Factors
In addition to the symptoms of preterm labor, physicians may identify specific risk factors that predispose patients to increased risk of preterm labor and delivery:

Current preterm labor
History of preterm labor/delivery
Multiple gestation pregnancy
Uterine/cervical anomaly

Facts About Home Uterine Activity Monitoring

Studies have shown that women accurately perceive approximately 15 percent of their preterm uterine contractions and that factors such as maternal weight, number of infants and parity all impact a woman's ability to detect uterine contractions. Home uterine activity monitoring devices accurately detect uterine contractions even at early gestational ages.

Home uterine activity monitoring used as a component of a comprehensive preterm labor management program has been shown to significantly reduce the costs associated with antepartum hospitalizations and early delivery in women with preterm labor. Plan of care decisions can be based on sound, objective data rather than on patient perception.