When should I consider referring a patient with preterm labour to a specialist unit?

Consider referring a patient with preterm labour to a specialist obstetric unit if:

• They have established preterm labour, defined as progressive cervical dilatation from 4 cm with regular contractions, or diagnosed preterm labour confirmed by positive diagnostic tests. Referral is important for appropriate monitoring and management including potential interventions such as tocolysis, corticosteroids, and neonatal care planning ¹.
• They have preterm prelabour rupture of membranes (P-PROM) before 37+0 weeks but are not in established labour, as specialist input is needed to manage risks and plan birth ¹.
• They have medical or obstetric risk factors that increase the risk of complications, such as multiple pregnancy, placenta praevia, pre-eclampsia requiring preterm birth, previous obstetric complications (e.g., unexplained stillbirth, neonatal death, uterine rupture), or significant maternal medical conditions (e.g., cardiac disease, severe anaemia, infections) ².
• They present with malpresentation (e.g., breech) between 26+0 and 36+6 weeks, where caesarean birth may be considered and specialist assessment is required ¹.
• They belong to groups at increased risk of adverse outcomes, such as women from minority ethnic backgrounds or deprived areas, who may need closer monitoring and additional support ¹.

Referral to a specialist unit ensures access to neonatal intensive care, specialist obstetric care, and multidisciplinary support necessary for optimal outcomes in preterm labour ¹,².