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How can obstetricians improve outcomes for infants born extremely preterm?
Stefan C Kane1, Katie M Groom2, Caroline A Crowther3
1The University of Melbourne, Department of Obstetrics and Gynaecology, Parkville, Victoria, 3052, Australia; Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, 3052, Australia.
Insights
Obstetricians can improve outcomes for extremely preterm infants by using antenatal corticosteroids, magnesium sulfate, and other interventions. Strategies for in-utero transfer and predicting preterm birth are also crucial for enhancing neonatal survival.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Perinatal Health
Background:
- Prematurity is a major cause of infant illness and death, with lasting health consequences.
- Obstetric care significantly impacts outcomes for extremely preterm infants.
- Effective interventions are needed to reduce prematurity-related morbidity and mortality.
Purpose of the Study:
- To review evidence-based obstetric interventions for managing pregnancies at risk of extreme preterm birth.
- To evaluate strategies for optimizing care, including antenatal treatments, transfers, and delivery methods.
- To provide guidance for obstetricians on improving outcomes for extremely preterm neonates.
Main Methods:
- Literature review of obstetric interventions for extreme preterm birth.
- Analysis of evidence for antenatal corticosteroids, magnesium sulfate, tocolysis, and antibiotics.
- Evaluation of strategies for in-utero transfer, preterm birth prediction, and mode of delivery.
Main Results:
- Antenatal corticosteroids and magnesium sulfate are key interventions.
- In-utero transfer to tertiary centers improves outcomes.
- Predictive strategies and optimized delivery methods are essential.
Conclusions:
- Obstetricians play a vital role in managing extreme preterm birth.
- Evidence supports specific antenatal interventions and delivery strategies.
- Coordinated care, including timely transfer and prediction, enhances infant survival and long-term health.
Abstract:
Prematurity remains a leading cause of perinatal morbidity and mortality, and also has significant implications for long-term health. Obstetricians have a key role to play in improving outcomes for infants born at extremely preterm gestations. This review explores the evidence for interventions available to obstetricians caring for women at risk of birthing at extremely preterm gestations, including antenatal corticosteroids, magnesium sulfate, tocolysis and antibiotics. It also addresses the importance of strategies to facilitate safe in-utero transfer, to maximise the chance of extremely preterm births occurring in tertiary centers, and the clinical value of strategies by which preterm birth can be predicted. The paper concludes with an appraisal of evidence for different modes of birth at extremely preterm gestations, and for delayed cord clamping.
