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[Preterm delivery: detection of risks and preventive treatment]
Insights
Preventing preterm birth is challenging, but screening for asymptomatic bacteriuria and bacterial vaginosis can help. Prenatal corticosteroids also reduce neonatal complications from premature delivery.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Public Health
Context:
- Approximately 13 million premature births occur globally each year, disproportionately affecting developing nations and contributing significantly to perinatal morbidity and mortality.
- Existing scientific literature was reviewed to identify effective interventions for preventing preterm birth and mitigating its neonatal consequences.
Purpose:
- To analyze scientifically validated data on interventions aimed at preventing preterm deliveries and reducing their impact on neonatal health.
- To evaluate the efficacy of various strategies, including risk factor identification, prevention, treatment of preterm labor, and prevention of neonatal respiratory distress syndrome.
Summary:
- Few methods effectively predict, prevent, or enable early detection of preterm delivery risk.
- Recommended interventions include screening and treating asymptomatic bacteriuria in all pregnancies and bacterial vaginosis in women with a history of preterm birth.
- Prophylactic cerclage is beneficial for women with multiple prior preterm births. Tocolytics (betamimetics, indomethacin) can delay delivery, while antenatal corticosteroids promote fetal lung maturation, reducing neonatal respiratory distress syndrome and mortality.
Impact:
- Screening for and treating asymptomatic bacteriuria and bacterial vaginosis are recommended for all pregnant women.
- Antenatal corticosteroid administration significantly reduces neonatal mortality by improving fetal lung maturity.
- Continued research is crucial for understanding preterm birth mechanisms and developing novel prevention and treatment strategies.
Abstract:
Every year around the world some 13 million premature children are born. Most of these children are born in developing countries, and they account for the largest share of perinatal morbidity and mortality. This review study analyzed scientifically validated data on interventions to prevent at least some portion of these preterm deliveries and to lessen their impact on neonatal health. The Cochrane and MEDLINE bibliographic databases were consulted. Fifty review pieces and research articles were studied, relating to the following aspects of preterm delivery: risk factors and early detection of the risk of preterm delivery; preventing the risk of preterm delivery; treating preterm delivery once it has begun; and preventing neonatal respiratory distress syndrome. There were few successful approaches to the prediction, prevention, or early detection of the threat of preterm delivery. The only measures that can be recommended for all pregnant women are screening for and treating asymptomatic bacteriuria as a part of prenatal check-ups. Screening for bacterial vaginosis and treating it reduce the incidence of preterm births in pregnant women with a history of premature delivery. In addition, prophylactic cerclage decreases the incidence of premature births in pregnant women who have had more than three preterm births. To treat a delivery that starts early, with or without premature membrane rupture, the interventions that have proved to be effective are administering betamimetics to the parturient woman in order to delay delivery for 48 hours, and using indomethacin for the same purpose, as the second-choice drug. The prenatal administration of corticosteroids to the pregnant woman can induce lung maturation in the fetus and reduce respiratory distress syndrome and ventricular hemorrhage, thus decreasing neonatal mortality. There is a need to continue and support basic and epidemiological research in order to develop new knowledge on the causes and mechanisms of preterm delivery and on preventing the morbidity and mortality that preterm delivery produces.