Table 4. Implications for practice.

This table presents a list of questions derived from our findings and may help programme managers, policymakers, researchers, and other key stakeholders to identify and address factors that may affect implementation and scale-up of ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM. Assessing the extent to which the barriers and facilitators identified in our review are potential implementation challenges in different settings is a useful starting point for formative research to scale up these preterm birth management interventions.

Domain	List of questions
Accurate assessment of gestational age	1. Are health providers aware of ultrasound dating in the management of preterm birth? 2. Is an ultrasound equipment available at the health facility, and is there consistent coverage of skilled sonographers or health providers in ultrasound dating? 3. Is early trimester ultrasound as recommended by WHO routinely practiced?
Guidelines and perceived knowledge	4. Are providers aware of the benefits of the ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM for preterm birth management? 5. Do providers have any scepticism or concerns about adverse effects of preterm birth management that can be addressed? 6. Do national guidelines have clear criteria on appropriate use of the ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM, including the following:     a. Guidance on assessing imminent preterm birth?     b. Appropriate gestational criteria for administration and determination of appropriate gestational age?     c. Determination of signs of maternal infection and contraindication of use when maternal infection is present?     d. Minimum standards for appropriate facilities to administer interventions, including essential newborn care?     e. Which cadre of providers can prescribe and administer the interventions?     f. Specific populations in which the interventions can or cannot be administered? 7. Are guidelines and clinical protocols on of ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM consistent between WHO, national, and facility levels?
Administration of interventions	8. Can administration of ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM be simplified through packaged or ready-to-use doses? 9. Are relevant drugs readily available in the antenatal, labour, and emergency wards? 10. Is there sufficient funding and budget allocation to ensure continuous procurement and distribution of ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM? 11. Has communication about administration and dosing during handover and referral been standardised?
Appropriate settings for administration	12. Do facilities administering ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM have adequate childbirth and preterm newborn care environments (such as resuscitation, thermal care, feeding support, infection treatment, and safe oxygen use)? 13. Can diagnosis of imminent preterm birth can be made lower-level health facility? 14. Can a prereferral dose be administered at a lower-level health facility? 15. Can improvements be made to the referral system, including transport?
Strategies to improve use	16. Have health providers received sufficient training on use of ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM? 17. Are there available reminder systems and educational materials on ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM available and accessible? 18. Are key performance indicators and audit and feedback available for ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM? 19. Have change champions or opinion leaders to promote use of ACS, tocolytics, magnesium sulphate for fetal neuroprotection, and antibiotics for PPROM been appointed at health facility?
Women’s acceptability on using interventions	20. Do women and partners receive education and educational materials on signs of preterm birth and preterm birth management early in pregnancy? 21. Do women have sufficient time and opportunity to discuss preterm birth management plans with health providers?

ACS, antenatal corticosteroid; PPROM, preterm prelabour rupture of membranes; WHO, World Health Organisation.