Table 1 Tommy's Clinical Decision Tool assessments, key input variables and care pathway recommendations

Preterm birth assessment

All women, at booking, 8–12 weeks’ gestation.

• Demographic characteristics.

• NHS number.

• Medical history.

• Obstetric history.

• If low risk: standard care (as per NICE guidelines).

• If moderate risk: cervical length at 17–21 weeks’ gestation.

• If high risk: refer to preterm birth service.

Placental function assessment

All women at booking or before 16 weeks’ gestation.

• Demographic characteristics.

• Medical history.

• Blood pressure (BP).

• Results from 1st trimester ultrasound scan (USS): crown rump length (CRL); uterine artery dopplers.

• Blood test result: PAPP-A MoM

• If low risk: standard care (as per NICE guidelines).

• If moderate risk: 2 additional USSs for fetal growth assessment and timing of birth (ToB) discussion.

• If high risk: 150 mg aspirin daily, additional 3 USSs and ToB discussion.

Changes in fetal movements (FM) assessment

Women presenting with changes in fetal movements.

• Results of placental function assessment (auto populated).

• Gestation at attendance.

• Number of attendances within the last four weeks.

• Presence of gestational diabetes or gestational hypertension.

Dependent on individualised risk:

• Fetal heart auscultation (< 28 weeks).

• computerised cardiotocograph (cCTG) (if had USS in last 2 weeks).

• cCTG and USS.

• Refer to maternal fetal medicine specialist.

• Consider offering induction of labour or caesarean birth.

Possible preterm labour assessment

Women presenting with symptoms of threatened preterm labour.

• Demographic characteristics.

• Medical history.

• Obstetric history.

• Fetal fibronectin (fFN) test result and/or cervical length measurement.

Dependent on individualised risk of birth within 7 days:

• < 5%: Observation ± discharge

• ≥ 5%: Steroids for fetal lung maturation and admission ± in utero transfer to hospital with available neonatal cot, if required.

Timing of birth assessment

Women ≥ 36 weeks identified as moderate or high risk of placental dysfunction.

• Estimated fetal weight (EFW).

• Umbilical artery pulsatility index (UA PI).

• Middle cerebral artery pulsatility index (MCA PI).

Dependent on individualised risk:

• Offer birth from 40 weeks.

• Offer birth from 39 weeks.

• Offer birth from 37 weeks.

• Refer to Specialist/Fetal Medicine.