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Predicting preterm delivery and lowering very preterm delivery rate
1Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia. ziva.novak@guest.arnes.si
Insights
Preterm birth rates have not decreased despite known risks. Integrating prospective data on stress, anxiety, and inflammation alongside retrospective biomedical factors is crucial for early prediction and intervention to improve survival rates.
Area of Science:
- Perinatal medicine
- Reproductive health
- Public health
Background:
- Preterm birth (PTD) remains a significant challenge, with survival and quality of life dependent on gestational age.
- Despite extensive research into risk factors, PTD rates have stagnated over the past decade.
- Current perinatal databases primarily rely on retrospective biomedical data, limiting predictive accuracy.
Purpose of the Study:
- To address the stagnation in PTD rates by improving prediction and intervention strategies.
- To advocate for the integration of prospective assessments of psychosocial and physiological factors into PTD prediction models.
- To emphasize the need for preconception and early pregnancy prediction and intervention.
Main Methods:
- Retrospective analysis of existing perinatal databases.
- Prospective assessment of risk factors including stress, anxiety, inflammation (e.g., elevated CRH), and cervical length.
- Implementation and auditing of targeted interventions.
Main Results:
- Current retrospective approaches are insufficient for reducing PTD rates.
- Prospective data integration is essential for accurate PTD prediction.
- Effective interventions, including addressing psychosocial factors, are key to lengthening pregnancies and reducing very preterm birth (VPTB) rates.
Conclusions:
- A shift towards prospective data collection and analysis is necessary for effective PTD prevention.
- Addressing psychosocial factors like stress, anxiety, social determinants, and discrimination is critical, though challenging.
- A compassionate approach and widespread implementation of interventions, coupled with continuous auditing, can significantly improve outcomes and reduce VPTD rates.
Abstract:
The chances and quality of survival depend on gestational age at birth. Why has PTD not decreased during the last decade, in spite of all the known risk factors? Perinatal data bases tend to include biomedical risk factors and are assembled and analysed retrospectively. These data should form the basis for prediction, and risk factors such as stress, anxiety, inflammation (leading to elevated CRH with its role in PTD), short cervix etc, should be added when assessed prospectively. The goal is preconception and early prediction in pregnancy. Only with the implementation of efficient intervention will we lengthen pregnancies and lower the VPTD rate. More articles about the PTD and complications of preterm births should be published in the lay press. There is no room for pessimism: if everybody involved would do just a little in the right direction, the result would be enormous. Constant auditing of interventions is necessary. The most difficult to "cure" and most likely to relapse are stress, anxiety and social factors, and discrimination in obtaining basic health care. Long forgotten lessons of compassion with pregnant women have not yet been acknowledged as proven to change VPTD into PTD, but are available at no cost world wide.