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Updated: Jan 11, 2026

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Implementation protocol for a treatment bundle targeting modifiable risk factors for preterm birth.

Gabrieli Roque de Castro1, Bianca Milani Biazotto2, Isabela Rodrigues da Silva1

  • 1Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil.

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|November 12, 2025
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Summary

This study introduces a low-cost intervention to manage preterm birth (PTB) risk factors in pregnant women. Early screening and treatment of smoking, vaginal infections, and short cervix can improve pregnancy outcomes.

Keywords:
Preterm birthimplementation researchprematurity preventionshort cervixvaginal dysbiosis

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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Maternal-Fetal Medicine

Background:

  • Preterm birth (PTB) is a leading cause of neonatal mortality globally.
  • Current PTB prevention strategies are not widely implemented, especially in high-prevalence areas.
  • Effective management of modifiable risk factors is crucial for reducing adverse pregnancy outcomes.

Purpose of the Study:

  • To implement a simple, low-cost intervention bundle for identifying and managing major modifiable risk factors for PTB.
  • To assess the feasibility and impact of this protocol in a high-prevalence setting in Jaú - SP, Brazil.
  • To reduce the incidence of PTB through proactive risk factor management.

Main Methods:

  • Inclusion of first-trimester pregnant women in Brazil with high PTB rates.
  • Utilized a questionnaire for smoking status and clinical history.
  • Incorporated Gram staining for vaginal microbiota assessment (Nugent's criteria) and cervical infection screening.
  • Transvaginal ultrasound to measure cervical length.

Main Results:

  • Pregnant smokers received auricular acupuncture and support group referrals.
  • Patients with vaginal dysbiosis received treatment and hygiene advice.
  • Women diagnosed with cervical shortening were treated with vaginal progesterone.
  • The study demonstrated the importance of active PTB risk factor management in high-risk populations.

Conclusions:

  • A simple, low-cost intervention bundle can effectively address modifiable PTB risk factors.
  • Early identification and management of smoking, vaginal infections, and cervical length are vital.
  • Implementing such protocols in high-prevalence settings can significantly impact maternal and neonatal outcomes.