The focus of this toolkit is to support implementation of the key elements of Antenatal Optimisation (AO). The toolkit provides an implementation strategy for units and networks who wish to improve compliance with key evidence-based AO interventions to improve preterm outcomes.

Toolkit aims

  • All women who are at risk of preterm birth (including both those in threatened preterm labour and those requiring intervention because of maternal or fetal indications), are identified appropriately and in a timely manner using evidence-based methods.
  • All women giving birth before 34 weeks of gestation, should receive a full course of antenatal steroids no longer than 7 days prior to birth, and ideally completed 24-48 hours before birth.
  • All women giving birth before 30 weeks of gestation, should receive a loading dose and ideally a minimum of 4 hour infusion of antenatal magnesium sulphate within the 24 hours prior to birth.
  • All women in established preterm labour (<37 weeks) should receive intrapartum antibiotic prophylaxis to prevent early onset neonatal Group B Streptococcal (GBS) infection irrespective of whether they have ruptured amniotic membranes.
  • Singleton infants less than 27 weeks of gestation, multiples less than 28 weeks of gestation and any gestation with an estimated fetal weight of less than 800g should be born in a maternity service on the same site as a neonatal intensive care unit (NICU).

This improvement activity referred to in this toolkit is not intended to be read as a guideline which mandates a standard improvement journey for all units. Instead it is a practical resource from which units who wish to improve compliance rates of antenatal optimisation measures can select the most suitable interventions for their particular context.

Full Toolkit (PDF)

Aims, Evidence and Rationale (PDF)

Your Improvement Journey (PDF)

Case Reporting Tool (word)

Education Slides (powerpoint)

Antenatal Optimisation Publications

Webinar: Introducing the AO Toolkit (video)

16/2/21 The Full Toolkit and Aims, Evidence and Rationale have been updated to correct an error. In the diagram 'Antenatal Optimisation to Improve Preterm Outcomes- the rationale' the text now says '1 fewer baby with infection for 10 GBS+ women treated in PTL.' The previous version said '9 GBS+ women'. 

If you have any feedback about this publication please do contact us.

British Association of Perinatal Medicine (BAPM) is registered in England & Wales under charity number 1199712 at 5-11 Theobalds Road, London, WC1X 8SH.
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