Supporting Antenatal Counselling for Anticipated Preterm Births at the Limits of Viability in Non-Tertiary Centres
Bibliographic record
Abstract
Background: Presentations of preterm labour at <25 weeks of gestational age (GA) require timely evidence-based counselling and management to optimise outcomes and facilitate informed decisions. In non-tertiary centres, this counselling is often especially challenging. Objectives: (1) To develop a tool to support counselling for preterm births at <25 weeks of GA, and (2) to refine and facilitate the utilisation of this tool and develop targeted supports through an understanding of challenges to providing counselling in non-tertiary centres. Methods: Perinatal risk factors and local outcome data were incorporated into a counselling tool. Semi-structured virtual interviews were conducted with participants with experience in counselling or receiving care at <25 weeks of GA in non-tertiary centres. Interviewees included transport team members, paediatricians, obstetricians, one family physician, and one parent. Analysis using interpretive description methodology was performed to identify themes in participant practice and experience. Results: A risk-based counselling tool was developed, including guidance for counselling discussions. Twenty-one interviews were completed. Practice challenges that were identified included a lack of updated knowledge on practices in tertiary centres, discomfort in providing counselling, variability in counselling content, and a variation in health care provider teams involved in counselling. All providers expressed a desire for further education in this area. Conclusions: Support for providers in non-tertiary centres in the counselling of periviable preterm families is much needed. The development of our practice tool targeted for non-tertiary centres provides an important step in this process. The next steps include responding to the expressed need from providers for education and training in the counselling and management of periviable preterm pregnancies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.030 | 0.086 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.005 | 0.008 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.010 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".