Preterm birth prevention: where are we?

OBJECTIVE The purpose of this study was to review the current approaches to preventing preterm delivery. STUDY DESIGN The problem of preterm birth was assessed by reviewing the different components that play a role in preterm birth prevention, excluding infection, antibiotic treatment, and tocolytic treatment. RESULTS Prevention of preterm labor must initially discriminate those at risk. Positive predictive values of various approaches are currently not adequate enough to warrant intervention. Prevention modalities, in part because of poor prediction, are mostly unproved. Accurate diagnoses of preterm labor remains difficult and confuses analyses of tocolytic agents. Cervicovaginal fetal fibronectin, perhaps in combination with cervical evaluation, shows promise. Early detection programs remain controversial, but most reviews indicate that daily patient contact with high-risk patients gives cause for some optimism. Antenatal maternal glucocorticoid treatment at specific gestational ages improves neonatal outcome. CONCLUSION The incidence of preterm birth is rising in the country. However, improved definition of the various components of the problem has provided an improved understanding of the problem. There is a new continuing effort and a search for new and innovative ways to address this vexing national problem.