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Preterm labour: association between labour physiology, tocolysis and prevention
Sebastián E Illanes1, Alejandra Pérez-Sepúlveda, Gregory E Rice
1Universidad de Los Andes, Department of Obstetrics & Gynaecology and Laboratory of Reproductive Biology, Faculty of Medicine , Santiago , Chile.
Insights
Preterm birth remains a major public health concern. New strategies, including progesterone and cerclage, show promise in reducing premature births and improving neonatal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Reproductive Health
Background:
- Preterm birth is a leading cause of perinatal morbidity and mortality in developed nations.
- Despite extensive research, preterm birth rates have been increasing, posing a significant public health challenge.
- Current understanding of preterm labor (PTL) pathophysiology and tocolytic drug efficacy requires further advancement.
Purpose of the Study:
- To review the physiopathology of labor and its implications for managing preterm labor (PTL) syndrome.
- To explore the rationale behind current and potential management strategies for PTL.
- To identify areas for future research and clinical intervention in PTL.
Main Methods:
- This study is a review focusing on the physiopathology of labor.
- It examines existing management approaches for the PTL syndrome.
- The review synthesizes current knowledge on PTL and discusses future directions.
Main Results:
- The review highlights the need for novel therapeutic tools for PTL management.
- Research into tocolysis, labor physiology, and pathological processes is crucial for new PTL treatments.
- Prophylactic use of progesterone pessary and cerclage has demonstrated success in reducing preterm births and improving neonatal outcomes in high-risk women.
Conclusions:
- Developing new treatment modalities for PTL is essential.
- Advancements in understanding tocolysis, labor physiology, and PTL pathology can lead to innovative therapies.
- Prediction models are vital for early preventative strategies, alongside interventions like progesterone and cerclage, to manage this multifactorial condition effectively.
Introduction:
In developed countries, preterm birth is the major cause of perinatal morbidity, mortality and the most important public health problem in the obstetric field. In the past decades, an increasing trend has been observed regardless of the great efforts focussed on the improvement of our understanding of the physiopathological mechanisms behind preterm labour (PTL) and the improvement in the use of tocolytic drugs.
Areas Covered:
In this review, the authors focus on some points of the physiopathology of labour in order to understand the rationality behind the different management approaches developed for the PTL syndrome.
Expert Opinion:
There is a need to develop new tools for the treatment of patients with PTL. Research focussed on improving tocolysis, the physiology of labour and pathological processes involved in PTL would afford new approaches for the treatment of PTL, allowing clinicians to provide integrative solutions for this multifactorial disease. Recently, the prophylactic use of progesterone pessary and cerclage in women with high risk of premature labour has been reported to reduce the incidence of premature births and improve neonatal outcomes. These results highlight the importance of prediction models in order to establish preventative strategies early in pregnancy.
