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Updated: Oct 4, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Preterm birth risk assessment
1Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425, USA.
Insights
Preventing preterm birth remains a challenge, as rates have increased despite tocolytic use. While fetal fibronectin and ultrasound are effective, home uterine monitoring has not proven beneficial for reducing preterm birth.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- Preterm birth is a primary cause of infant morbidity and mortality, with national rates near 11%.
- Despite extensive use of tocolytic agents, the incidence of preterm birth has risen in the U.S. over the last three decades.
- The etiology of preterm birth is multifactorial, involving potential insults to the uteroplacental barrier, fetal stress pathways, cervical incompetence, and uterine distention.
Purpose of the Study:
- To review biochemical and biophysical markers for identifying women at risk of preterm delivery.
- To evaluate the efficacy of various predictive methods in managing and preventing preterm birth.
Main Methods:
- Review of existing studies on biochemical markers (e.g., fetal fibronectin, salivary estriol).
- Analysis of biophysical markers, specifically endovaginal ultrasound assessment of cervical length.
- Evaluation of home uterine activity monitoring systems.
Main Results:
- Fetal fibronectin assays and endovaginal ultrasound are effective in identifying symptomatic women at low risk for preterm birth.
- Salivary estriol shows promise as a reliable risk identifier in high-risk populations.
- Home uterine activity monitoring has not demonstrated a reduction in preterm birth frequency or associated neonatal complications.
Conclusions:
- Certain markers, like fetal fibronectin and cervical ultrasound, are valuable tools for risk stratification in preterm birth prediction.
- Further research is needed for markers such as salivary estriol to confirm their role in clinical practice.
- Current evidence does not support the use of home uterine activity monitoring for preventing preterm birth.
Abstract:
Preterm birth is a leading cause of peripheral morbidity and mortality. The national rate of prematurity approaches 11%. In spite of widespread tocolytic use, the preterm birth rate has actually increased over the past 30 years in the United States. Preterm birth appears to have a multifactorial etiology. Leading theories include infectious, inflammatory or ischemic insult to the uteroplacental barrier, activation of the fetal hypothalamic-pituitary pathway, decreased cervical competence, and pathologic uterine distention. Multiple biochemical and biophysical markers have been studied for their potential to correctly identify women at risk of preterm delivery. Of these, fetal fibronectin and endovaginal ultrasound examination of the cervix have proven effective in predicting which symptomatic women are actually at low risk of preterm birth. Salivary estriol is being studied as a marker for preterm labor and delivery and it too will likely be found to be a reliable risk identifier in a high risk population. However, home uterine activity monitoring has not been shown to decrease the frequency of preterm birth or its neonatal complications.
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