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Preterm Birth Prevention – Risks, Diagnosis & Treatment
Preterm birth prevention includes all measures aimed at avoiding birth before 37 weeks of gestation. Early diagnosis and targeted treatment protect both mother and child.
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Preterm birth prevention includes all measures aimed at avoiding birth before 37 weeks of gestation. Early diagnosis and targeted treatment protect both mother and child.
What is Preterm Birth Prevention?
Preterm birth prevention refers to the full range of medical, nursing, and lifestyle measures designed to reduce the risk of preterm birth, defined as delivery before 37 completed weeks of gestation. Preterm birth is one of the leading causes of neonatal morbidity and mortality worldwide. Effective prevention strategies can significantly lower the risk and improve long-term outcomes for both mother and child.
Risk Factors for Preterm Birth
Identifying risk factors is the first step in preterm birth prevention. Key risk factors include:
- Previous preterm birth: Women who have previously delivered preterm carry a significantly elevated risk of recurrence.
- Cervical insufficiency: A shortened or weakened cervix (neck of the womb) can predispose to early labour.
- Multiple pregnancies: Twin or triplet pregnancies are associated with a higher risk of preterm delivery.
- Infections: Vaginal infections, urinary tract infections, or systemic illness can trigger early contractions.
- Uterine abnormalities: Structural malformations of the uterus increase the likelihood of preterm labour.
- Social and psychological stress: Stress, smoking, poor nutrition, and low socioeconomic status are all relevant contributing factors.
- Chronic maternal conditions: Diabetes, hypertension, and thyroid disorders may raise the risk.
Diagnostic Measures for Early Detection
Early identification of risk is essential. The most important diagnostic tools include:
- Cervical length measurement: Transvaginal ultrasound is used to assess cervical length. A measurement below 25 mm between 16 and 24 weeks of gestation is considered a warning sign.
- Fetal fibronectin test (fFN): The detection of this protein in vaginal secretions between 22 and 34 weeks of gestation may indicate an elevated risk of imminent preterm labour.
- CTG (cardiotocography): Monitoring of fetal heart rate and uterine contractions helps identify early abnormalities.
- Infection screening: Regular screening for vaginal infections such as bacterial vaginosis is a standard component of antenatal care.
Preventive Measures and Treatment Options
Pharmacological Therapy
Several pharmacological strategies are available for women at elevated risk:
- Progesterone: Vaginal progesterone has been shown to be effective in reducing the risk of preterm birth in women with a short cervix or a history of preterm delivery.
- Tocolytics (labour-inhibiting agents): Medications such as atosiban or fenoterol can suppress premature contractions and prolong pregnancy to allow time for further interventions.
- Corticosteroids: When preterm birth is imminent, corticosteroids (e.g. betamethasone) are administered to accelerate fetal lung maturation.
- Antibiotics: Targeted antibiotic treatment is indicated in cases of confirmed infection.
Surgical and Interventional Procedures
- Cervical cerclage: In cases of cervical insufficiency, a surgical stitch placed around the cervix can help stabilise and prolong the pregnancy.
- Arabin pessary: A silicone ring inserted vaginally to provide support to the cervix and reduce the risk of preterm labour.
Lifestyle and General Preventive Measures
- Avoidance of smoking and alcohol throughout pregnancy
- Balanced nutrition with adequate intake of folate, vitamin D, omega-3 fatty acids, and iron
- Stress reduction and sufficient rest
- Regular antenatal check-ups
- Prompt treatment of urinary tract and vaginal infections
The Role of Antenatal Care
Regular antenatal care forms the cornerstone of preterm birth prevention. Close collaboration between obstetricians, midwives, and other healthcare professionals enables early identification and targeted management of risk factors. Pregnant women with known risk factors should be monitored closely and referred to specialised centres when necessary.
References
- World Health Organization (WHO): Born Too Soon: The Global Action Report on Preterm Birth. Geneva, 2012. Available at: https://www.who.int/publications/i/item/9789241503433
- Honest H et al.: Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review. BMJ, 2002.
- Romero R et al.: Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data. American Journal of Obstetrics and Gynecology, 2018.
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