Acrobat
MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Twins: Antepartum assessment and Intrapartum management
Sponsored by The Indian Health Service Clinical Support Center
14 Twin Pregnancy: Double Trouble?
Step 14. A C O G resources
ACOG Guidelines for Perinatal Care, Chapter 4 – Multifetal Gestations
A C O G Members
Non-A C O G members
Assessment of Risk Factors for Preterm Birth
ACOG Practice Bulletin No. 31
Summary of Recommendations
The following recommendation is based on good and consistent scientific evidence (Level A):
- There are no current data to support the use of salivary estriol, HUAM, or BV screening as strategies to identify or prevent preterm birth.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Screening for risk of preterm labor by means other than historic risk factors is not beneficial in the general obstetric population.
- Ultrasonography to determine cervical length, fFN testing, or a combination of both may be useful in determining women at high risk for preterm labor. However, their clinical usefulness may rest primarily with their negative predictive value given the lack of proven treatment options to prevent preterm birth.
- Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negative values and a reduced risk of preterm birth, thereby avoiding unnecessary intervention.
Assessment of Risk Factors for Preterm Birth. ACOG Practice Bulletin No. 31. American College of Obstetricians and Gynecologists. Obstet Gynecol 2001 Oct;98(4):709-16.
Non-ACOG Members
ACOG Members
* ACOG Evidence grading system
The MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents were used to conduct a literature search to locate relevant articles published between January 1985 and October 2000. The search was restricted to articles published in the English language. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document.
Guidelines published by organizations or institutions such as the National Institutes of Health and the American College of Obstetricians and Gynecologists were reviewed, and additional studies were located by reviewing bibliographies of identified articles. When reliable research was not available, expert opinions from obstetrician–gynecologists were used. Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force:
- I Evidence: obtained from at least one properly designed randomized controlled trial.
- II -1 Evidence obtained from well-designed controlled trials without randomization.
- II -2 Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
- I I-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
- III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories:
- Level A—Recommendations are based on good and consistent scientific evidence.
- Level B—Recommendations are based on limited or inconsistent scientific evidence.
- Level C—Recommendations are based primarily on consensus and expert opinion.
