Prevention of preterm delivery: current challenges and future prospects
Authors van Zijl MD, Koullali B, Mol BWJ, Pajkrt E, Oudijk MA
Received 26 March 2016
Accepted for publication 29 June 2016
Published 31 October 2016 Volume 2016:8 Pages 633—645
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Elie Al-Chaer
Maud D van Zijl,1 Bouchra Koullali,1 Ben WJ Mol,2 Eva Pajkrt,1 Martijn A Oudijk1
1Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands; 2The Robinson Research Institute, School for Reproductive Health and Pediatrics, University of Adelaide, Adelaide, SA, Australia
Abstract: Preterm birth (PTB), defined as delivery at <37 weeks of gestation, is the most important cause of neonatal morbidity and mortality. Therefore, preventing PTB is one of the main goals in obstetric care. In this review, we provide an overview of the current available literature on screening for risk factors for PTB and a summary of preventive strategies in both low-risk and high-risk women with singleton or multiple gestations. Furthermore, current challenges and future prospects on PTB are discussed. For an optimal prevention of PTB, risk stratification should be based on a combination of (maternal) risk factors, obstetric history, and screening tools. Cervical length measurements can help identify women at risk. Thereafter, preventive strategies such as progesterone, pessaries, and cerclage may help prevent PTB. Effective screening and prevention of PTB vary between the different pregnancy populations. In singleton or multiple pregnancies with a short cervix, without previous PTB, a pessary or progesterone might prevent PTB. In women with a (recurrent) PTB in the past, progesterone and a cerclage may prevent recurrence. The effect of a pessary in these high-risk women is currently being studied. A strong collaboration between doctors, patients’ organizations, pharmaceutical companies, and (international) governments is needed to reduce the morbidity and mortality as a result of spontaneous PTB.
Keywords: preterm birth, prevention, risk factors, current challenges, future prospects
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