Materiały źródłowe

• #1 Treatments to Prevent Premature Birth (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/treatments-prevent-premature-birth.html

  Having a full-term pregnancy is best for your baby’s health. Full-term pregnancies usually last about 40 weeks. […] When a baby is born earlier than 37 weeks, it’s called a preterm or premature birth. Babies who are born early can have health problems that may last their whole lives. […] Some women are more likely to go into labor early. Those with a short or weak cervix (the lower part of the uterus that connects to the vagina) or who have had a premature baby before are more likely to go into labor early. In these cases, the doctor may recommend treatments such as: […] Progesterone: This hormone can be given as a shot or put into the vagina. It can help lower the chances of going into labor early for women who have had a premature baby before or who have a short cervix. […] Cerclage: In this procedure, stitches close a woman’s cervix to help prevent preterm birth. Doctors may recommend cerclage (sair-KLAZH) for women who have had premature babies or miscarriages, who have a short cervix, or who have a cervix that begins to open (dilate) too early.

• #2 5 ways to prevent preterm birth | UK Healthcare

  https://ukhealthcare.uky.edu/wellness-community/blog-health-information/5-ways-prevent-preterm-birth

  Prematurity and its complications are the leading cause of death in children younger than 5 in the world today. […] While some risks for premature birth cannot be avoided, there are things you can do to help prevent a preterm birth. Here are a few tips: […] Stop smoking, or cut down to less than a half-pack per day. Smoking contributes to preterm birth, and a baby who lives in a house with smokers is also 3.5 times more likely to die of sudden infant death syndrome than a baby who doesn’t. […] Avoid alcohol and drugs. […] Get prenatal care. […] Practice oral hygiene and see your dentist. Oral infections can lead to infections that can cause preterm labor. […] Practice stress reduction. Be aware of how you are handling stress and get sufficient exercise and rest to help get you ready for your new family member. […] Delivering at full term will help your baby be healthier, stronger and avoid the complications that come with preterm birth.

• #3 Preterm Labor: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0315/p366.html

  In the United States, preterm delivery is the leading cause of neonatal morbidity and is the most common reason for hospitalization during pregnancy. […] Antenatal progesterone is associated with a significant decrease in subsequent preterm delivery in certain pregnant women. Current recommendations are to prescribe vaginal progesterone in women with a shortened cervix and no history of preterm delivery, and to use progesterone supplementation regardless of cervical length in women with a history of spontaneous preterm delivery. […] A course of corticosteroids is the only antenatal intervention that has been shown to improve postdelivery neonatal outcomes, including a reduction in neonatal mortality, intracranial hemorrhage, necrotizing enterocolitis, and neonatal infection. […] When used in specific at-risk populations, magnesium sulfate provides neuroprotection and decreases the incidence of cerebral palsy in preterm infants.

• #4

  https://journals.lww.com/mfm/fulltext/2020/07000/preterm_birth,_from_the_biological_knowledges_to.6.aspx

  The primary prevention for PTB consists in the early identification of risk factors and education. Several risk factors are non-modifiable, such as history of PTB, extremes maternal ages (18 years and 35 years), multiple pregnancies, short CL, previous uterine surgeries, male sex and nulliparity, ethnicity and family history, and genetic factors. In addition, others factors are modifiable, such as nutrition, low socioeconomic status, extremes body mass index (BMI), poor pregnancy weight gain, smoking, substance abuse, short inter-pregnancy interval, periodontal disease, genital infections, late or no prenatal care, untreated antenatal depression, and use of assisted reproductive technologies. For these variables clinicians can act an effective prevention, also in the pre-conceptional period, a critical window during which health-care professionals can help women to prepare as well as possible for the pregnancy.

• #5 Preterm labor and preterm birth: Are you at risk? | March of Dimes

  https://www.marchofdimes.org/find-support/topics/birth/preterm-labor-and-preterm-birth-are-you-risk

  Preterm labor and preterm birth happen too early, before 37 weeks of pregnancy. […] Talk to your provider about what you can do to help reduce your risk for preterm labor and preterm birth. […] If you’re having preterm labor, your provider may give you treatment to help stop it. Or you may get treatment to help improve your baby’s health before birth. Talk to your provider about which treatments may be right for you. […] We do know some things may make you more likely than others to have preterm labor and preterm birth. These are called risk factors. […] Talk to your health care provider about what you can do to help reduce your risk. […] These three risk factors make you most likely to have preterm labor and give birth early: You’ve had a preterm baby in the past. […] Medical risk factors before pregnancy for preterm labor and preterm birth include being underweight or overweight before pregnancy.

• #6 Facts About Premature Birth: Prevention and Treatment – CHOC Children’s

  https://choc.org/articles/facts-about-premature-birth-prevention-treatment/

  A premature baby is born before 37 weeks of gestation. […] Risk factors for giving birth prematurely are: having a prior premature birth, being pregnant with multiple babies like twins or triplets, having chronic medical problems, having an infection during pregnancy, and engaging in high-risk behavior like smoking, drinking alcohol or taking drugs. […] Ways to minimize the risk for a premature delivery include eating a healthy diet, lowering stress, not smoking or doing drugs, and managing all medical conditions with the help of a doctor. […] To help prevent premature birth, women are encouraged to seek prenatal care throughout their pregnancy. This will help identify any problems that could lead to a preterm birth. […] If a woman thinks she will deliver prematurely, it is important to make a birth plan that includes partnering with a hospital that has experience treating premature babies.

• #7 Preterm Labor: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4498-premature-labor

  Premature birth (or preterm birth) is when a baby is born before 37 weeks of pregnancy. Babies born before 37 weeks can have health complications like trouble breathing or low birth weight. […] If you have a history of preterm birth, your obstetrician may recommend medication to prevent you from going into labor too soon. The most commonly used medication is progesterone. It involves inserting a progesterone suppository into your vagina. In some cases, your provider will recommend a cervical cerclage. Its a procedure in which your cervix is stitched closed to prevent it from dilating. […] Its hard to prevent going into labor early, but there are some ways to lower your risk for preterm labor. Some things you can do are: Dont smoke cigarettes, drink alcohol, use recreational drugs or improperly use prescription drugs. Get to a healthy weight before pregnancy and gain an appropriate amount of weight during pregnancy. Eat healthy foods and take a prenatal vitamin. Find ways to reduce or manage your stress levels. Stay active, go for walks, read books or take time to relax every day. Go to all prenatal appointments and schedule a cleaning with your dentist. Theres a link between your gum health and preterm labor. Get treated for or manage any medical conditions you have like hypertension, gestational diabetes, depression or vaginal infections. Space your pregnancies by at least 12 to 18 months.

• #8 Premature Birth and Its Prevention | ABC Law Centers: Birth Injury Lawyers

  https://www.abclawcenters.com/practice-areas/premature-birth-and-prevention/

  If a baby is born before 37 weeks of gestation, they are considered premature. Premature birth is often preventable – doctors can prolong a pregnancy to the proper time using the hormone progesterone or a procedure called cervical cerclage if they promptly diagnose issues that are risk factors for premature birth. […] There are ways that medical practitioners can decrease the risk of preterm birth, especially when analyzing a mother’s prior health history closely. […] First and foremost, it’s very important for medical practitioners to take a full and accurate health history of the mother to identify any potential risk factors for preterm birth. If a mother has these risk factors, doctors and nurses should monitor her pregnancy more closely than that of a mother without risk factors. […] Depending on a mother’s health history, the kinds of interventions that may be recommended can differ.

• #9 10 Ways to Reduce the Risk of Another Preterm Birth | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/womens-health/pregnancy-birth/preterm-birth/10-ways-to-reduce-risk-of-another-birth

  Preterm labor and birth or giving birth to a preemie isn’t well understood. Because doctors don’t fully understand why it happens, there are few reliable ways to completely predict it or prevent it. However, studies have shown that there are ways you can lower your chance of having another preemie. […] Waiting 18 months before you get pregnant again allows time for your body to heal and reduces your chance of having another preterm birth. […] The best way to ensure an 18-month space between pregnancies is to use the most effective methods of contraception, which include the IUD or implant. […] For women who have a history of preterm birth, a special form of progesterone called 17P can lower your chance of having another preemie. […] In fact, 17P is one of the most effective treatments available for women with a history of giving birth to preemies. Studies show that treatment with 17P lowers your chance of another preterm birth by about one-third (30 percent).

• #10 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  There are six strategies currently available with various levels of evidence of effectiveness that are suitable for translation into clinical practice in high-resource settings and have a high chance of successfully preventing a proportion of preterm births. […] The most feasible approach to rapidly lowering the overall rate of preterm birth is to address non-medically indicated late preterm birth. […] Late preterm birth is a potential danger to the child. Infants born in the late preterm period are physiologically and metabolically immature. […] Strategies addressing the increase in late preterm and early term births will be enhanced by an understanding of the demographic characteristics of those most at-risk. […] For several decades, there has been interest in the potential use of progesterone supplementation to prevent preterm birth but a series of recent studies has now provided strong evidence for their usefulness. […] In women with a past history of preterm birth, progesterone has been shown in meta-analysis of RCTs to significantly reduce the risk of preterm birth 34weeks (RR 0.31 95% CI 0.140.69), preterm birth 37weeks (RR 0.55, 95% CI 0.420.74), perinatal death (RR 0.50, 95% CI 0.330.75), need for assisted ventilation (RR 0.40, 95% CI 0.180.90), necrotizing enterocolitis (RR 0.30, 95% CI 0.100.89), and admission to neonatal intensive care (RR 0.24, 95% CI 0.140.40).

• #11 Updated Clinical Guidance for the Use of Progestogen Supplementation for the Prevention of Recurrent Preterm Birth | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2023/04/updated-guidance-use-of-progestogen-supplementation-for-prevention-of-recurrent-preterm-birth

  This Practice Advisory serves to update the current evidence and recommendations for the use of progestogen for the prevention of recurrent preterm birth. […] Vaginal progesterone may be considered as a treatment option for patients with a history of preterm birth, singleton gestation, and a shortened cervix. However, vaginal progesterone has not been proven effective in the absence of a shortened cervix and should not be considered as an alternative to 17-OHPC. […] With regard to the use of prophylactic 17-OHPC specifically for the prevention of recurrent preterm birth, the FDAs assessment of the current body of evidence concluded that there were not sufficient data to indicate that this was an effective treatment in the broad population it was originally approved for all pregnant people with a prior spontaneous preterm birth between 20 and 37 weeks of gestation.

• #12 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  There are six strategies currently available with various levels of evidence of effectiveness that are suitable for translation into clinical practice in high-resource settings and have a high chance of successfully preventing a proportion of preterm births. […] The most feasible approach to rapidly lowering the overall rate of preterm birth is to address non-medically indicated late preterm birth. […] Late preterm birth is a potential danger to the child. Infants born in the late preterm period are physiologically and metabolically immature. […] Strategies addressing the increase in late preterm and early term births will be enhanced by an understanding of the demographic characteristics of those most at-risk. […] For several decades, there has been interest in the potential use of progesterone supplementation to prevent preterm birth but a series of recent studies has now provided strong evidence for their usefulness. […] In women with a past history of preterm birth, progesterone has been shown in meta-analysis of RCTs to significantly reduce the risk of preterm birth 34weeks (RR 0.31 95% CI 0.140.69), preterm birth 37weeks (RR 0.55, 95% CI 0.420.74), perinatal death (RR 0.50, 95% CI 0.330.75), need for assisted ventilation (RR 0.40, 95% CI 0.180.90), necrotizing enterocolitis (RR 0.30, 95% CI 0.100.89), and admission to neonatal intensive care (RR 0.24, 95% CI 0.140.40).

• #13 Interventions to prevent spontaneous preterm birth in women with singleton pregnancy who are at high risk: systematic review and network meta-analysis | The BMJ

  https://www.bmj.com/content/376/bmj-2021-064547

  Vaginal progesterone should be considered the preventative treatment of choice for women with singleton pregnancy identified to be at risk of spontaneous preterm birth because of a history of spontaneous preterm birth or short cervical length. […] Vaginal progesterone was associated with fewer women with preterm birth 34 weeks (odds ratio 0.50, 95% credible interval 0.34 to 0.70, high certainty of evidence). […] Vaginal progesterone was associated with fewer perinatal deaths compared with control treatment (0.66, 0.44 to 0.97, moderate certainty). […] Future randomised controlled trials should use vaginal progesterone as a comparator to identify better treatments or combination treatments. […] Vaginal progesterone seems to be the best preterm birth prevention treatment for women with a singleton pregnancy who are at high risk and are asymptomatic. […] It will be increasingly difficult to offer no treatment or placebo to women with singleton pregnancy who have been identified at risk of preterm birth. We suggest that vaginal progesterone should become the new gold standard comparator.

• #14 How To Prevent Preterm Birth – Preterm Alliance

  https://pretermalliance.com.au/mothers-to-be/how-to-prevent-preterm-birth/

  Until quite recently, preterm birth has been considered to be an unavoidable and accidental consequence of pregnancy. Thankfully, those times have changed and preterm birth is now considered to be preventable, at least in a proportion of cases. Several decades of research have provided us with the knowledge to safely lower the rate of preterm birth. […] The following preterm birth prevention interventions will be recommended for application into all clinical practices over the coming years. […] The length of your cervix in mid-pregnancy is a strong predictor of your risk of preterm birth. […] If your cervix is less than 25mm on an internal scan your doctor needs to prescribe natural vaginal progesterone 200mg given as a pessary. This treatment should continue until 36 weeks gestation and is expected to halve the risk of preterm birth.

• #15 How To Prevent Preterm Birth – Preterm Alliance

  https://pretermalliance.com.au/mothers-to-be/how-to-prevent-preterm-birth/

  Vaginal progesterone 200mg pessaries are also to be prescribed for any case in which there is a history of spontaneous preterm birth in a previous pregnancy between 20 and 34 weeks gestation. […] Smoking is a major and totally avoidable cause of preterm labour. […] For women at very high risk of preterm birth, you may speak to your doctor about being referred to specialists in the field of preterm birth prevention. […] The Alliance recommends that fertility treatments be used with appropriate caution and applied with a full understanding of the potential to increase the risk of early birth. […] Medical professionals will be encouraged to advise women to prepare for a future pregnancy by optimising their health and seeking pre-conception counselling. This is especially important for women who have an increased risk of preterm birth resulting from a personal or family history of early birth, prior surgical intervention on the woman’s cervix, or recurrent miscarriages, or those at the extremes of maternal age or where the inter-pregnancy intervals may be less than 18 months.

• #16 Preventing Preterm Labor | NYU Langone Health

  https://nyulangone.org/conditions/preterm-labor/prevention

  Preterm (or premature) labor happens when a womans body prepares for birth before the baby is fully developed in the womb. […] At NYU Langone, our doctors aim to keep labor from starting before week 34 of pregnancy to give the baby more time to develop. […] It is not always possible to prevent preterm labor. However, NYU Langone doctors recommend the following strategies to help ensure that you have a healthy pregnancy and your baby has as much time as possible to develop before birth. […] If your cervix measures less than 2.5 centimeters in length, your doctor may prescribe a vaginal suppository containing a hormone called progesterone. This treatment has been shown to reduce preterm births by about 40 percent. […] Doctors at NYU Langone may recommend the following tips to prevent preterm labor.

• #17 What treatments are used to prevent preterm labor and birth? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/preterm/conditioninfo/treatments

  Currently, treatment options for preventing preterm labor or birth are somewhat limited, in part because the cause of preterm labor or birth is often unknown. […] Hormone treatment. Progesterone, a hormone produced by the body during pregnancy, was thought to prevent preterm birth in certain groups at high risk of preterm birth, such as those with a prior preterm birth. […] NICHDs Maternal-Fetal Medicine Units Network found that progesterone given to women at risk of preterm birth due to a prior preterm birth reduces chances of a subsequent preterm birth by one-third, when started at 16 weeks of gestation and continued to 37 weeks of gestation. […] Because subsequent research did not show the same effect, use of progesterone to prevent preterm birth is now under review by the U.S. Food and Drug Administration.

• #18 What treatments are used to prevent preterm labor and birth? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/preterm/conditioninfo/treatments

  Currently, treatment options for preventing preterm labor or birth are somewhat limited, in part because the cause of preterm labor or birth is often unknown. […] Hormone treatment. Progesterone, a hormone produced by the body during pregnancy, was thought to prevent preterm birth in certain groups at high risk of preterm birth, such as those with a prior preterm birth. […] NICHDs Maternal-Fetal Medicine Units Network found that progesterone given to women at risk of preterm birth due to a prior preterm birth reduces chances of a subsequent preterm birth by one-third, when started at 16 weeks of gestation and continued to 37 weeks of gestation. […] Because subsequent research did not show the same effect, use of progesterone to prevent preterm birth is now under review by the U.S. Food and Drug Administration.

• #19 Preterm Birth Prevention Alliance. – National Consumers League

  https://nclnet.org/pbp/

  Mothers deserve access to the best possible treatments to prevent preterm birth. […] The Preterm Birth Prevention Alliance is a coalition of maternal and women’s health advocates who share a common concern about the state of preterm birth in the United States and the proposed market withdrawal of 17P, the only FDA-approved class of treatments to help prevent spontaneous, recurrent preterm birth. […] The FDA has announced that it expects to hold a long-awaited hearing on the future of 17P on October 17-19, 2022. […] The Preterm Birth Prevention Alliance believes that preterm birth and its disproportionate impact on women of color provide a key example of why we need representative research and Real-World Evidence on treatment efficacy across populations. […] Only one FDA-approved intervention currently exists to help pregnant women prevent a recurrent preterm birth. It is a prescription medicine called hydroxyprogesterone caproate, which is also known as “17P” or “17-OHPC.”

• #20 New medicines for spontaneous preterm birth prevention and preterm labour management: landscape analysis of the medicine development pipeline | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05842-9

  There are few medicines in clinical use for managing preterm labor or preventing spontaneous preterm birth from occurring. […] The objectives of this study were to 1) analyse the research and development pipeline of medicines for preterm birth and 2) compare these medicines to target product profiles for spontaneous preterm birth to identify the most promising candidates. […] The AIM database identified 178 candidates. Of the 71 candidates in clinical development, ten were deemed high potential (Prevention: Omega-3 fatty acid, aspirin, vaginal progesterone, oral progesterone, L-arginine, and selenium; Treatment: nicorandil, isosorbide dinitrate, nicardipine and celecoxib) and seven were medium potential (Prevention: pravastatin and lactoferrin; Treatment: glyceryl trinitrate, retosiban, relcovaptan, human chorionic gonadotropin and Bryophyllum pinnatum extract).

• #21 New medicines for spontaneous preterm birth prevention and preterm labour management: landscape analysis of the medicine development pipeline | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05842-9

  We identified six high priority candidates for spontaneous preterm birth prevention (omega-3 fatty acids, aspirin, vaginal and oral progesterone, pravastatin, l-arginine and selenium) and four high priority candidates for management of preterm labour (nicorandil, isosorbide dinitrate, nicardipine and celecoxib), which warrant RD investment.

• #22

  https://journals.lww.com/mfm/fulltext/2020/07000/preterm_birth,_from_the_biological_knowledges_to.6.aspx

  Considering the public health relevance of PTB and its negative related consequences, innovative interventions should be studied and analyzed in large and well-designed clinical trials. The current essay briefly treat the main clues for PTB syndrome, focusing on current preventive strategies available to try to limit the adverse outcomes. […] Currently, screening, while imperfect, is done based on pregnant history and on measuring the CL (the strongest clinical predictor of PTB in asymptomatic women), as well as fFN levels and CL assessment, the latter in singleton pregnancies with acute PTL symptoms. These approaches still remain to be proven in multiple pregnancies. […] Interestingly, a review of systematic reviews on PTB prevention was published. In total 112 reviews were included in the analysis: sixty papers assessed the effect of primary prevention interventions on risk of PTB. Positive effects were reported for lifestyle and behavioral changes (including diet and exercise); nutritional supplements (including calcium and zinc supplementation); nutritional education; screening for lower genital tract infections. Eighty-three systematic reviews were identified relating to secondary PTB prevention interventions. Positive effects were found for low dose aspirin (LDASA) among women at risk of pre-eclampsia; clindamycin treatment for bacterial vaginosis (BV); treatment of vaginal candidiasis; progesterone in women with prior spontaneous PTB and in those with short mid-trimester CL; L-arginine in women at risk for preeclampsia; levothyroxine among women with thyroid disease; calcium supplementation in women at risk of hypertensive disorders; smoking cessation; CL screening in women with history of PTB with placement of cerclage in those with short cervix; cervical pessary in singleton gestations with short cervix; and treatment of periodontal disease. The overview serves as a guide to current evidence relevant to PTB prevention. Only few interventions have been demonstrated to be effective, including cerclage, progesterone, LDASA, and lifestyle and behavioral changes. For several of the interventions analyzed, there was insufficient evidence to assess whether they were really effective or not.

• #23 Preterm Labor: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0315/p366.html

  A recent reduction in preterm deliveries in the United States may partially be the result of newer recommendations from the American College of Obstetricians and Gynecologists. These recommendations include progesterone treatment for those at high risk of preterm delivery, stricter guidelines for assisted reproductive technology, and the reduction of elective early term deliveries before 39 weeks’ gestation. […] Cervical cerclage has been used to help correct structural defects or cervical weakening in high-risk women with a shortened cervix. Studies have shown that cerclage is associated with a decrease in preterm delivery and in perinatal death when used in women with a prior preterm delivery and a cervical length of 25 mm or less. […] One trial evaluated the use of cervical pessary and found that the rate of delivery before 34 weeks’ gestation was significantly lower in women with a pessary vs. those without a pessary. […] Although several trials have been conducted, no studies have shown that use of antibiotics during preterm labor is effective in delaying delivery or reducing neonatal morbidity associated with preterm delivery.

• #24 Treatments to Prevent Premature Birth (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/treatments-prevent-premature-birth.html

  Having a full-term pregnancy is best for your baby’s health. Full-term pregnancies usually last about 40 weeks. […] When a baby is born earlier than 37 weeks, it’s called a preterm or premature birth. Babies who are born early can have health problems that may last their whole lives. […] Some women are more likely to go into labor early. Those with a short or weak cervix (the lower part of the uterus that connects to the vagina) or who have had a premature baby before are more likely to go into labor early. In these cases, the doctor may recommend treatments such as: […] Progesterone: This hormone can be given as a shot or put into the vagina. It can help lower the chances of going into labor early for women who have had a premature baby before or who have a short cervix. […] Cerclage: In this procedure, stitches close a woman’s cervix to help prevent preterm birth. Doctors may recommend cerclage (sair-KLAZH) for women who have had premature babies or miscarriages, who have a short cervix, or who have a cervix that begins to open (dilate) too early.

• #25 What treatments are used to prevent preterm labor and birth? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/preterm/conditioninfo/treatments

  A surgical procedure called cervical cerclage is sometimes used to try to prevent early labor in women who have an incompetent (weak) cervix and have experienced early pregnancy loss accompanied by a painless opening (dilation) of the cervix (the bottom part of the uterus). […] In the cerclage procedure, a doctor stitches the cervix closed. […] Contrary to expectations, confining the mother to bed rest does not help to prevent preterm birth. […] In fact, bed rest can make preterm birth even more likely among some women. […] Women should discuss all of their treatment options including the risks and benefits with their health care providers.

• #26 Preterm Birth Prevention Care – NYC | ColumbiaDoctors

  https://www.columbiadoctors.org/specialties/obstetrics-gynecology/our-services/preterm-birth-prevention

  A preterm birth is any birth that occurs before the 37th week of pregnancy. Preterm birth complicates 10 percent of births in the United States and is a leading cause of perinatal mortality and long-term neonatal morbidity. […] The Preterm Birth Prevention Center at Columbia University Irving Medical Center was created to improve perinatal outcomes by providing individualized, evidence-based care to patients at risk for preterm birth and promoting cutting-edge, multidisciplinary research. […] With decades of experience in preterm birth prevention, our team takes a personalized approach to care for women in high-risk groups. Through review of your records and obstetric history, we will work with you to determine which interventions will lower your risk for preterm birth. […] Common interventions include: Vaginal cerclage: A surgical procedure in which a stitch is placed into the cervix to help strengthen it. This is performed through the vagina and during pregnancy.

• #27 Preterm Birth Prevention Care – NYC | ColumbiaDoctors

  https://www.columbiadoctors.org/specialties/obstetrics-gynecology/our-services/preterm-birth-prevention

  Transabdominal cerclage: A surgical procedure in which a stitch is placed into the cervix to help strengthen it. This stich is placed in the cervix through an abdominal surgery, generally robotically, and can be placed before or during pregnancy. […] Progesterone supplementation: Vaginal progesterone therapy is used to reduce the risk of preterm birth in women with a history of preterm birth or who have a short cervix. […] Cervical length monitoring: Transvaginal ultrasounds that are performed to determine the length of the cervix. […] Our team is also involved in clinical, translational, and basic science research designed to understand and decrease the occurrence of preterm delivery.

• #28 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  Cervical cerclage is the surgical placement of a suture or tape around the cervix in an attempt to prevent dilatation and subsequent preterm birth. […] Meta-analysis of the RCTs that have compared cervical cerclage against no treatment has shown a significant reduction in preterm births of 20% (average RR 0.80, 95% CI 0.690.95) and with a reduction in perinatal deaths although this difference did not quite reach statistical significance (RR 0.78; 95% CI 0.611.00). […] Tobacco smoking in pregnancy causes preterm birth in addition to a dose-dependent reduction in birthweight. […] Nevertheless, the risk of preterm birth attributable to smoking has been estimated as more than 25% and reducing smoking rates in pregnant women must be of highest priority. […] The advent of fertility assistance has contributed to a significant increase in the rate of preterm birth. […] The risk of preterm birth that may result from fertility treatment can best be addressed by education of the attending health-care practitioners.

• #29 Preterm Labor: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0315/p366.html

  A recent reduction in preterm deliveries in the United States may partially be the result of newer recommendations from the American College of Obstetricians and Gynecologists. These recommendations include progesterone treatment for those at high risk of preterm delivery, stricter guidelines for assisted reproductive technology, and the reduction of elective early term deliveries before 39 weeks’ gestation. […] Cervical cerclage has been used to help correct structural defects or cervical weakening in high-risk women with a shortened cervix. Studies have shown that cerclage is associated with a decrease in preterm delivery and in perinatal death when used in women with a prior preterm delivery and a cervical length of 25 mm or less. […] One trial evaluated the use of cervical pessary and found that the rate of delivery before 34 weeks’ gestation was significantly lower in women with a pessary vs. those without a pessary. […] Although several trials have been conducted, no studies have shown that use of antibiotics during preterm labor is effective in delaying delivery or reducing neonatal morbidity associated with preterm delivery.

• #30

  https://journals.lww.com/mfm/fulltext/2020/07000/preterm_birth,_from_the_biological_knowledges_to.6.aspx

  About progesterone use, in contemporary practice its role in PTB prevention is important. Progesterone is an essential hormone in the process of reproduction: it has been largely studied in the treatment of several gynecological and obstetrics conditions (contraceptions, abnormal uterine bleeding, assisted reproductive technologies). However, its pathophysiology of pregnancy remains debated. Progesterone, oral or intramuscular, is recognized as an effective prevention strategy in women with singleton gestations and with previous PTB. […] Cerclage and pessary were proposed as other possible strategies for PTB prevention. Several studies support the benefit of cerclage for women with singleton pregnancies, history of PTB, and short mid-trimester cervix 25 mm. Cervical pessary has been tried as a simple, non-invasive alternative that might replace the cerclage (an invasive procedure that needs anesthesia) to prevent PTB.

• #31 Care for Preterm Birth Complications – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/pregnancy-complications/preterm-birth

  Medications that stop contractions (tocolytics) are helpful when receiving the course of steroid injections over 48 hours, but they are not recommended for long-term use during pregnancy. […] Vaginal progesterone is helpful in pregnancies with a short cervix and high risk of preterm delivery. […] Intramuscular progesterone is a proven therapy for the prevention of recurrent preterm birth. […] This device is a soft, flexible ring that is placed inside of the mothers vagina by her obstetric care provider to help prevent preterm labor in those patients who are at higher risk, including those with a shorter cervix. […] Placement of an encompassing suture around the cervix may be appropriate for some women who have a history of a prior mid pregnancy loss, or if during a current pregnancy ultrasound surveillance or physical exam indicates notable shortening or opening of the cervix.

• #32 Care for Preterm Birth Complications – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/pregnancy-complications/preterm-birth

  Medications that stop contractions (tocolytics) are helpful when receiving the course of steroid injections over 48 hours, but they are not recommended for long-term use during pregnancy. […] Vaginal progesterone is helpful in pregnancies with a short cervix and high risk of preterm delivery. […] Intramuscular progesterone is a proven therapy for the prevention of recurrent preterm birth. […] This device is a soft, flexible ring that is placed inside of the mothers vagina by her obstetric care provider to help prevent preterm labor in those patients who are at higher risk, including those with a shorter cervix. […] Placement of an encompassing suture around the cervix may be appropriate for some women who have a history of a prior mid pregnancy loss, or if during a current pregnancy ultrasound surveillance or physical exam indicates notable shortening or opening of the cervix.

• #33 Preterm Labor: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0315/p366.html

  A recent reduction in preterm deliveries in the United States may partially be the result of newer recommendations from the American College of Obstetricians and Gynecologists. These recommendations include progesterone treatment for those at high risk of preterm delivery, stricter guidelines for assisted reproductive technology, and the reduction of elective early term deliveries before 39 weeks’ gestation. […] Cervical cerclage has been used to help correct structural defects or cervical weakening in high-risk women with a shortened cervix. Studies have shown that cerclage is associated with a decrease in preterm delivery and in perinatal death when used in women with a prior preterm delivery and a cervical length of 25 mm or less. […] One trial evaluated the use of cervical pessary and found that the rate of delivery before 34 weeks’ gestation was significantly lower in women with a pessary vs. those without a pessary. […] Although several trials have been conducted, no studies have shown that use of antibiotics during preterm labor is effective in delaying delivery or reducing neonatal morbidity associated with preterm delivery.

• #34

  https://journals.lww.com/mfm/fulltext/2020/07000/preterm_birth,_from_the_biological_knowledges_to.6.aspx

  About progesterone use, in contemporary practice its role in PTB prevention is important. Progesterone is an essential hormone in the process of reproduction: it has been largely studied in the treatment of several gynecological and obstetrics conditions (contraceptions, abnormal uterine bleeding, assisted reproductive technologies). However, its pathophysiology of pregnancy remains debated. Progesterone, oral or intramuscular, is recognized as an effective prevention strategy in women with singleton gestations and with previous PTB. […] Cerclage and pessary were proposed as other possible strategies for PTB prevention. Several studies support the benefit of cerclage for women with singleton pregnancies, history of PTB, and short mid-trimester cervix 25 mm. Cervical pessary has been tried as a simple, non-invasive alternative that might replace the cerclage (an invasive procedure that needs anesthesia) to prevent PTB.

• #35 Preterm Labor: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4498-premature-labor

  Premature birth (or preterm birth) is when a baby is born before 37 weeks of pregnancy. Babies born before 37 weeks can have health complications like trouble breathing or low birth weight. […] If you have a history of preterm birth, your obstetrician may recommend medication to prevent you from going into labor too soon. The most commonly used medication is progesterone. It involves inserting a progesterone suppository into your vagina. In some cases, your provider will recommend a cervical cerclage. Its a procedure in which your cervix is stitched closed to prevent it from dilating. […] Its hard to prevent going into labor early, but there are some ways to lower your risk for preterm labor. Some things you can do are: Dont smoke cigarettes, drink alcohol, use recreational drugs or improperly use prescription drugs. Get to a healthy weight before pregnancy and gain an appropriate amount of weight during pregnancy. Eat healthy foods and take a prenatal vitamin. Find ways to reduce or manage your stress levels. Stay active, go for walks, read books or take time to relax every day. Go to all prenatal appointments and schedule a cleaning with your dentist. Theres a link between your gum health and preterm labor. Get treated for or manage any medical conditions you have like hypertension, gestational diabetes, depression or vaginal infections. Space your pregnancies by at least 12 to 18 months.

• #36 Preterm labor and preterm birth: Are you at risk? | March of Dimes

  https://www.marchofdimes.org/find-support/topics/birth/preterm-labor-and-preterm-birth-are-you-risk

  Having certain health conditions during pregnancy can increase your risk for preterm labor and preterm birth. […] Other medical risk factors during pregnancy include getting late or no prenatal care. […] Risk factors in your everyday life for preterm labor and preterm birth include smoking, drinking alcohol, using street drugs or abusing prescription drugs. […] Yes, you may be able to reduce your risk for early labor and birth. […] Here’s what you can do to reduce your risk for preterm labor and preterm birth: Get to a healthy weight before pregnancy and gain the right amount of weight during pregnancy. […] Don’t smoke, drink alcohol, use street drugs or abuse prescription drugs. […] Get treated for chronic health conditions, like high blood pressure, diabetes, depression and thyroid problems. […] Reduce your stress.

• #37 Preventing Preterm Labor | NYU Langone Health

  https://nyulangone.org/conditions/preterm-labor/prevention

  Therefore, NYU Langone doctors recommend waiting at least 12 months between birth and the next pregnancy, especially in women who have had preterm labor before. […] Its also important when planning a pregnancy to limit alcohol to no more than two drinks per week, to refrain from using recreational drugs, and to quit smoking, as smoking has been linked to preterm labor and other health risks for mothers and babies. […] NYU Langone doctors recommend that you drink plenty of fluids throughout the day while pregnant to prevent dehydration, which can trigger contractions. […] Because urinary tract infections can increase the risk of preterm labor, its important that you report to your doctor any urinary symptoms, including burning while urinating, difficulty urinating, or a feeling that your bladder hasnt completely emptied after urinating.

• #38 10 Ways to Reduce the Risk of Another Preterm Birth | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/womens-health/pregnancy-birth/preterm-birth/10-ways-to-reduce-risk-of-another-birth

  Studies have shown that progesterone shots are safe for both mother and baby. Your chance of having another preemie may be reduced if you take the shots. […] Overweight and underweight women have a higher chance of giving birth to preemies. […] Smoking increases your odds of having a preemie. […] If you have a chronic disease (such as heart disease, diabetes, high blood pressure, or autoimmune disease), work with your health care provider to make sure it is well controlled before your next pregnancy. […] Fertility treatment may increase your chance of getting pregnant with more than one baby. […] A consultation (where you talk face-to-face with a specialist about your unique situation) will give you specific information on how to reduce YOUR chance of having another preemie. […] Women who receive good prenatal care have a lower chance of giving birth to a preemie. […] Experts recommend that every woman of childbearing age take folic acid, even if she’s not planning to become pregnant. Long-term supplementation helps prevent certain birth defects and may lower your chance of having a preemie.

• #39 Preterm Birth | Maternal Infant Health | CDC

  https://www.cdc.gov/maternal-infant-health/preterm-birth/index.html

  Preterm labor is labor that happens too soon, before 37 weeks of pregnancy. If you think you are experiencing signs of preterm labor, see a health care provider right away. Your provider may be able to give you medicine so that the baby will be healthier at birth. […] Preventing preterm birth remains a challenge because causes may not always be well understood. However, pregnant women can take important steps to help reduce their risk of preterm birth and improve their general health: […] Seek medical attention for any signs or symptoms of preterm labor. […] Talk with your doctor if you had a previous preterm birth. […] Another step women and their partners can take to reduce the risk is to wait at least 18 months between pregnancies. […] CDC’s Division of Reproductive Health recently expanded support to 36 Perinatal Quality Collaboratives (PQCs). Funding supports the capabilities of PQCs to improve the quality of perinatal care in their states. This includes efforts to reduce preterm birth.

• #40 10 Ways to Reduce the Risk of Another Preterm Birth | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/womens-health/pregnancy-birth/preterm-birth/10-ways-to-reduce-risk-of-another-birth

  Preterm labor and birth or giving birth to a preemie isn’t well understood. Because doctors don’t fully understand why it happens, there are few reliable ways to completely predict it or prevent it. However, studies have shown that there are ways you can lower your chance of having another preemie. […] Waiting 18 months before you get pregnant again allows time for your body to heal and reduces your chance of having another preterm birth. […] The best way to ensure an 18-month space between pregnancies is to use the most effective methods of contraception, which include the IUD or implant. […] For women who have a history of preterm birth, a special form of progesterone called 17P can lower your chance of having another preemie. […] In fact, 17P is one of the most effective treatments available for women with a history of giving birth to preemies. Studies show that treatment with 17P lowers your chance of another preterm birth by about one-third (30 percent).

• #41 10 Ways to Reduce the Risk of Another Preterm Birth | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/womens-health/pregnancy-birth/preterm-birth/10-ways-to-reduce-risk-of-another-birth

  Studies have shown that progesterone shots are safe for both mother and baby. Your chance of having another preemie may be reduced if you take the shots. […] Overweight and underweight women have a higher chance of giving birth to preemies. […] Smoking increases your odds of having a preemie. […] If you have a chronic disease (such as heart disease, diabetes, high blood pressure, or autoimmune disease), work with your health care provider to make sure it is well controlled before your next pregnancy. […] Fertility treatment may increase your chance of getting pregnant with more than one baby. […] A consultation (where you talk face-to-face with a specialist about your unique situation) will give you specific information on how to reduce YOUR chance of having another preemie. […] Women who receive good prenatal care have a lower chance of giving birth to a preemie. […] Experts recommend that every woman of childbearing age take folic acid, even if she’s not planning to become pregnant. Long-term supplementation helps prevent certain birth defects and may lower your chance of having a preemie.

• #42 Treatments to Prevent Premature Birth (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/treatments-prevent-premature-birth.html

  Preterm birth can’t always be prevented. But you can help lower your chances of going into labor too soon. Here’s the best advice: […] If you’re pregnant or planning to become pregnant, meet with your doctor. Women who get regular prenatal care are more likely to have a healthier pregnancy and baby.

• #43 10 Ways to Reduce the Risk of Another Preterm Birth | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/womens-health/pregnancy-birth/preterm-birth/10-ways-to-reduce-risk-of-another-birth

  Studies have shown that progesterone shots are safe for both mother and baby. Your chance of having another preemie may be reduced if you take the shots. […] Overweight and underweight women have a higher chance of giving birth to preemies. […] Smoking increases your odds of having a preemie. […] If you have a chronic disease (such as heart disease, diabetes, high blood pressure, or autoimmune disease), work with your health care provider to make sure it is well controlled before your next pregnancy. […] Fertility treatment may increase your chance of getting pregnant with more than one baby. […] A consultation (where you talk face-to-face with a specialist about your unique situation) will give you specific information on how to reduce YOUR chance of having another preemie. […] Women who receive good prenatal care have a lower chance of giving birth to a preemie. […] Experts recommend that every woman of childbearing age take folic acid, even if she’s not planning to become pregnant. Long-term supplementation helps prevent certain birth defects and may lower your chance of having a preemie.

• #44 Preterm Labor and Preterm Birth Prevention | Duke Health

  https://www.dukehealth.org/treatments/obstetrics-and-gynecology/preterm-labor-and-preterm-birth-prevention

  Prevention can begin before you become pregnant. We offer preconception consultations to women who have a history of delivering a premature baby or who have risk factors or a medical condition that puts them at high risk for preterm labor. These sessions provide insights into the possible reasons a premature birth occurred and offer potential prevention measures for future pregnancies. […] If you are pregnant and at elevated risk for preterm delivery, you will meet with a perinatologist who specializes in managing high-risk pregnancies. He or she will evaluate your condition, carefully review your medical history, and develop a comprehensive preterm birth prevention plan. Some medical interventions must be started as early as the first trimester, so it’s best to seek care as soon as your baby’s heartbeat has been confirmed.

• #45 Preterm Labor and Preterm Birth Prevention | Duke Health

  https://www.dukehealth.org/treatments/obstetrics-and-gynecology/preterm-labor-and-preterm-birth-prevention

  Our goal is to maintain your pregnancy to 37 weeks or beyond. […] This hormone supplement may help reduce your risk of preterm delivery. Depending on your needs, progesterone may be given vaginally in the form of a suppository, capsule or gel, or via weekly injections. Progesterone therapy works best when it is started between weeks 16 and 20 of your pregnancy. […] If an ultrasound indicates you have a weak cervix — called cervical insufficiency — a stitch may be placed vaginally or abdominally to keep the cervix closed and prevent it from opening before the pregnancy reaches full term. […] Your specialized care to prevent preterm birth will coincide with standard prenatal care that includes fetal monitoring, overall health evaluations for you, and prenatal testing. […] These ongoing studies help our perinatologists better understand the causes of preterm birth in hopes of reducing rates in the future.

• #46 Preventing Preterm Labor | NYU Langone Health

  https://nyulangone.org/conditions/preterm-labor/prevention

  Therefore, NYU Langone doctors recommend waiting at least 12 months between birth and the next pregnancy, especially in women who have had preterm labor before. […] Its also important when planning a pregnancy to limit alcohol to no more than two drinks per week, to refrain from using recreational drugs, and to quit smoking, as smoking has been linked to preterm labor and other health risks for mothers and babies. […] NYU Langone doctors recommend that you drink plenty of fluids throughout the day while pregnant to prevent dehydration, which can trigger contractions. […] Because urinary tract infections can increase the risk of preterm labor, its important that you report to your doctor any urinary symptoms, including burning while urinating, difficulty urinating, or a feeling that your bladder hasnt completely emptied after urinating.

• #47 Premature Birth: Symptoms, Risks, and Prevention – SCI Hospital

  https://scihospital.com/article/premature-birth-symptoms-risks-and-prevention

  Addressing Infections: Timely identification and treatment of infections in the mother can help reduce the risk of preterm birth. Regular screening and appropriate management of conditions such as urinary tract infections, bacterial vaginosis, and sexually transmitted infections are important. […] Management of Chronic Health Conditions: Effective management of chronic health conditions like diabetes, high blood pressure, and autoimmune disorders is crucial. Close monitoring, appropriate medication, and lifestyle modifications under the guidance of healthcare professionals can help minimize the risk of preterm birth. […] Avoiding Unnecessary Interventions: Unnecessary interventions such as early elective inductions or cesarean sections should be avoided unless medically indicated. The goal is to allow the pregnancy to progress naturally until full term when possible.

• #48 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  In recent years, many health regions and hospitals have developed dedicated preterm birth prevention clinics. […] Using a retrospective cohort design, investigators from Utah, USA reported a significant reduction in recurrent preterm birth (48.6 versus 63.4%) in women who attended a dedicated clinic and with lower rates of composite major neonatal morbidity (5.7 versus 16.3%). […] Intra-uterine infection and inflammation play a well-recognized role in the etiology of spontaneous preterm labor, particularly in deliveries less than 32weeks gestation. […] In summary, while a role for vaginal infection in the causal pathway to many cases of early preterm birth seems clear, at this time translation of that knowledge into an effective treatment strategy has yet to be widely adopted. […] It is well established that surgical treatments of cervical intra-epithelial neoplasia (CIN) predispose women to preterm birth in subsequent pregnancies, including early preterm birth. […] The discovery and introduction of a vaccine to prevent HPV infection can now be expected to dramatically reduce the prevalence of pre-invasive abnormalities of the cervix and hence decrease the need for surgical treatments that may predispose women to subsequent preterm births.

• #49 Preterm Birth | Maternal Infant Health | CDC

  https://www.cdc.gov/maternal-infant-health/preterm-birth/index.html

  Preterm labor is labor that happens too soon, before 37 weeks of pregnancy. If you think you are experiencing signs of preterm labor, see a health care provider right away. Your provider may be able to give you medicine so that the baby will be healthier at birth. […] Preventing preterm birth remains a challenge because causes may not always be well understood. However, pregnant women can take important steps to help reduce their risk of preterm birth and improve their general health: […] Seek medical attention for any signs or symptoms of preterm labor. […] Talk with your doctor if you had a previous preterm birth. […] Another step women and their partners can take to reduce the risk is to wait at least 18 months between pregnancies. […] CDC’s Division of Reproductive Health recently expanded support to 36 Perinatal Quality Collaboratives (PQCs). Funding supports the capabilities of PQCs to improve the quality of perinatal care in their states. This includes efforts to reduce preterm birth.

• #50 Preterm Labor: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0315/p366.html

  In women with a single gestation pregnancy and a history of spontaneous preterm delivery, progesterone supplementation is beneficial starting at 16 to 24 weeks’ gestation and continuing through 34 weeks’ gestation. […] Once preterm labor is confirmed, a single course of corticosteroids (betamethasone or dexamethasone) is the only intervention for improving neonatal outcomes. […] Antenatal magnesium sulfate provides neuroprotection, decreasing the risk of cerebral palsy in infants born at less than 32 weeks’ gestation. […] Tocolytics, such as prostaglandin inhibitors and calcium channel blockers, should be used to prolong the time to delivery so that antenatal corticosteroids and potentially magnesium sulfate can be administered, and the mother can be transferred to a tertiary facility with a neonatal intensive care unit.

• #51 Medical Treatment for Preterm Labor | NYU Langone Health

  https://nyulangone.org/conditions/preterm-labor/treatments/medical-treatment-for-preterm-labor

  Depending on your symptoms and the babys gestational age, your doctor may prescribe medication to delay or stop preterm labor. […] If you are showing signs of preterm labor and are less than 34 weeks pregnant, your doctor may administer a tocolytic medication to suppress labor and give your babys lungs more time to mature. Tocolytics can reduce contractions, thereby delaying labor, for up to several days. […] If you are less than 34 weeks pregnant and experiencing the symptoms of labor, your doctor may inject a corticosteroid called betamethasone into your arm, leg, or buttocks to help speed up the babys lung development and protect against brain complications. […] If you are less than 32 weeks pregnant and showing signs of labor, your doctor may give you magnesium. Magnesium decreases the odds that a preterm baby may have neurodevelopmental delays, and it may also help to slow down contractions.

• #52 Preterm Labor: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0315/p366.html

  In women with a single gestation pregnancy and a history of spontaneous preterm delivery, progesterone supplementation is beneficial starting at 16 to 24 weeks’ gestation and continuing through 34 weeks’ gestation. […] Once preterm labor is confirmed, a single course of corticosteroids (betamethasone or dexamethasone) is the only intervention for improving neonatal outcomes. […] Antenatal magnesium sulfate provides neuroprotection, decreasing the risk of cerebral palsy in infants born at less than 32 weeks’ gestation. […] Tocolytics, such as prostaglandin inhibitors and calcium channel blockers, should be used to prolong the time to delivery so that antenatal corticosteroids and potentially magnesium sulfate can be administered, and the mother can be transferred to a tertiary facility with a neonatal intensive care unit.

• #53 Preterm Labor: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0315/p366.html

  In the United States, preterm delivery is the leading cause of neonatal morbidity and is the most common reason for hospitalization during pregnancy. […] Antenatal progesterone is associated with a significant decrease in subsequent preterm delivery in certain pregnant women. Current recommendations are to prescribe vaginal progesterone in women with a shortened cervix and no history of preterm delivery, and to use progesterone supplementation regardless of cervical length in women with a history of spontaneous preterm delivery. […] A course of corticosteroids is the only antenatal intervention that has been shown to improve postdelivery neonatal outcomes, including a reduction in neonatal mortality, intracranial hemorrhage, necrotizing enterocolitis, and neonatal infection. […] When used in specific at-risk populations, magnesium sulfate provides neuroprotection and decreases the incidence of cerebral palsy in preterm infants.

• #54 Prevention of Preterm Birth

  https://naprotechnology.com/prevention/

  A prematurity prevention program has been developed and implemented at the Pope Paul VI Institute for the last 25 years. The program begins by identifying those patients who are at high risk for going into preterm labor. These patients are then taught how to self-monitor their uterine contractions. When indicated, supplemental intramuscular progesterone is provided while monitoring serum progesterone levels and tocolytic therapy (usually with Terbutaline) is used for symptoms of uterine irritability (contractions). […] This entire protocol cannot be properly discussed in a web site such as this, however, it can be stated emphatically that the prematurity rate can be decreased with the use of this protocol. The summary of delivery rates using the Pope Paul VI Institute Prematurity Prevention Program and comparing it to a comparison group is shown in Table 56-26 for the various gestational ages. For the entire group, the comparison group had a preterm birth rate of 12.0 percent and the Pope Paul VI Institute group protocol only had a 7.0 percent prematurity rate and in that group, only 1.3 percent were at to 33.9 weeks of gestation. This is three times less than the comparison group.

• #55 Prevention of Preterm Birth

  https://naprotechnology.com/prevention/

  A prematurity prevention program has been developed and implemented at the Pope Paul VI Institute for the last 25 years. The program begins by identifying those patients who are at high risk for going into preterm labor. These patients are then taught how to self-monitor their uterine contractions. When indicated, supplemental intramuscular progesterone is provided while monitoring serum progesterone levels and tocolytic therapy (usually with Terbutaline) is used for symptoms of uterine irritability (contractions). […] This entire protocol cannot be properly discussed in a web site such as this, however, it can be stated emphatically that the prematurity rate can be decreased with the use of this protocol. The summary of delivery rates using the Pope Paul VI Institute Prematurity Prevention Program and comparing it to a comparison group is shown in Table 56-26 for the various gestational ages. For the entire group, the comparison group had a preterm birth rate of 12.0 percent and the Pope Paul VI Institute group protocol only had a 7.0 percent prematurity rate and in that group, only 1.3 percent were at to 33.9 weeks of gestation. This is three times less than the comparison group.

• #56 New Preterm Birth Prevention Center Opens | Columbia University Irving Medical Center

  https://www.cuimc.columbia.edu/news/new-preterm-birth-prevention-center-opens

  The Preterm Birth Prevention Center, a new center dedicated to improving perinatal outcomes by providing personalized medical care for women at high risk for premature birth, has opened in Columbia University Irving Medical Centers Department of Obstetrics Gynecology. […] Preterm birth centers have been shown to significantly improve outcomes for patients at risk for preterm birth, which affected 1 in 10 babies in the United States in 2014 and is a leading cause of long-term neurological disabilities in children. […] Outpatient care will be offered at three locations in the New York City metropolitan area: midtown Manhattan, Washington Heights, and Bronxville. Patients will consult with a maternal fetal medicine specialist to develop a personalized preterm birth prevention plan. Common interventions to prevent preterm birth include vaginal and abdominal cerclage, progesterone supplements, and vaginal pessary, an experimental treatment.

• #57 Preterm Birth | Maternal Infant Health | CDC

  https://www.cdc.gov/maternal-infant-health/preterm-birth/index.html

  Preterm labor is labor that happens too soon, before 37 weeks of pregnancy. If you think you are experiencing signs of preterm labor, see a health care provider right away. Your provider may be able to give you medicine so that the baby will be healthier at birth. […] Preventing preterm birth remains a challenge because causes may not always be well understood. However, pregnant women can take important steps to help reduce their risk of preterm birth and improve their general health: […] Seek medical attention for any signs or symptoms of preterm labor. […] Talk with your doctor if you had a previous preterm birth. […] Another step women and their partners can take to reduce the risk is to wait at least 18 months between pregnancies. […] CDC’s Division of Reproductive Health recently expanded support to 36 Perinatal Quality Collaboratives (PQCs). Funding supports the capabilities of PQCs to improve the quality of perinatal care in their states. This includes efforts to reduce preterm birth.

• #58 CDC Grand Rounds: Public Health Strategies to Prevent Preterm Birth | MMWR

  https://www.cdc.gov/mmwr/volumes/65/wr/mm6532a4.htm

  Preterm birth (delivery before 37 weeks and 0/7 days of gestation) is a leading cause of infant morbidity and mortality in the United States. […] Reducing preterm birth, a national public health priority (2), can be accomplished by implementing and monitoring strategies that target modifiable risk factors and populations at highest risk, and by providing improved quality and access to preconception, prenatal, and interconception care through implementation of strategies with potentially high impact. […] Five groups of strategies can reduce the occurrence of preterm births. First, women of childbearing age need access to preconception care services including screening, health promotion, and interventions that will enable them to achieve high levels of wellness, minimize risks, and enter a pregnancy in optimal health. […] Second, women at risk for preterm delivery need to be identified and offered access to effective treatments to prevent preterm birth. […] A third strategy to prevent preterm birth is to discourage nonmedically indicated deliveries, especially before 39 0/7 weeks. […] A fourth strategy for reducing preterm birth is preventing unintended pregnancies and achieving optimal birth spacing. […] Finally, multiple gestations have a higher preterm birth risk.

• #59 CDC Grand Rounds: Public Health Strategies to Prevent Preterm Birth | MMWR

  https://www.cdc.gov/mmwr/volumes/65/wr/mm6532a4.htm

  Preterm birth (delivery before 37 weeks and 0/7 days of gestation) is a leading cause of infant morbidity and mortality in the United States. […] Reducing preterm birth, a national public health priority (2), can be accomplished by implementing and monitoring strategies that target modifiable risk factors and populations at highest risk, and by providing improved quality and access to preconception, prenatal, and interconception care through implementation of strategies with potentially high impact. […] Five groups of strategies can reduce the occurrence of preterm births. First, women of childbearing age need access to preconception care services including screening, health promotion, and interventions that will enable them to achieve high levels of wellness, minimize risks, and enter a pregnancy in optimal health. […] Second, women at risk for preterm delivery need to be identified and offered access to effective treatments to prevent preterm birth. […] A third strategy to prevent preterm birth is to discourage nonmedically indicated deliveries, especially before 39 0/7 weeks. […] A fourth strategy for reducing preterm birth is preventing unintended pregnancies and achieving optimal birth spacing. […] Finally, multiple gestations have a higher preterm birth risk.

• #60 Centers for Disease Control and Prevention Grand Rounds: Public Health Strategies to Prevent Preterm Birth – Healthy People 2030 | odphp.health.gov

  https://odphp.health.gov/healthypeople/tools-action/browse-evidence-based-resources/centers-disease-control-and-prevention-grand-rounds-public-health-strategies-prevent-preterm-birth

  This report presents public health strategies to prevent preterm birth and related complications. […] It highlights strategies that are intended to: […] Identify women at risk for preterm delivery and provide access to effective preventive treatments […] Discourage deliveries that aren’t medically necessary, especially before 39 weeks […] Prevent unintended pregnancies and achieve optimal birth spacing.

• #61 The Prematurity Prevention Initiative (PPI)

  https://cjfhc.org/what-we-do/community/prematurity-prevention-initiative.html

  Premature birth is a leading cause of infant mortality. Racial disparities in care lead to higher rates of preterm birth for Black and African American women. […] The Prematurity Prevention Initiatives goal is to reduce the number of babies born too soon and eliminate racial disparities in New Jersey through community and professional education programs. […] Educational presentations and resources are available for everyone! Free dynamic sessions highlight preventive care for expecting parents, healthcare barriers, and resources for parents with a history of preterm births. […] The Prematurity Prevention Initiative engages all community members and stakeholders collaborating to prevent preterm births those who are pregnant and their support network, the community at large and the system of health care and social service providers. The Prematurity Prevention Initiative is inclusive, serving all races, ethnicities, sexual/gender identities, income levels and insurance status. While all embracing, the Prematurity Prevention Initiative focuses special attention on those at greatest risk.

• #62 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  After several decades of research, we now have evidence that at least six interventions are suitable for immediate use in contemporary clinical practice within high-resource settings and can be expected to safely reduce the rate of preterm birth. These interventions involve strategies to prevent non-medically indicated late preterm birth; use of maternal progesterone supplementation; surgical closure of the cervix with cerclage; prevention of exposure of pregnant women to cigarette smoke; judicious use of fertility treatments; and dedicated preterm birth prevention clinics. […] The widespread use of human papillomavirus vaccination in girls and young women will decrease the need for surgical interventions on the cervix and can be expected to further reduce the risk of early birth. Together, this array of clinical interventions, each based on a substantial body of evidence, is likely to reduce rates of preterm birth and prevent death and disability in large numbers of children. The process begins with an acceptance that early birth is not an inevitable and natural feature of human reproduction. Preventative strategies are now available and need to be applied. The best outcomes may come from developing integrated strategies designed specifically for each health-care environment.

• #63 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  In recent years, many health regions and hospitals have developed dedicated preterm birth prevention clinics. […] Using a retrospective cohort design, investigators from Utah, USA reported a significant reduction in recurrent preterm birth (48.6 versus 63.4%) in women who attended a dedicated clinic and with lower rates of composite major neonatal morbidity (5.7 versus 16.3%). […] Intra-uterine infection and inflammation play a well-recognized role in the etiology of spontaneous preterm labor, particularly in deliveries less than 32weeks gestation. […] In summary, while a role for vaginal infection in the causal pathway to many cases of early preterm birth seems clear, at this time translation of that knowledge into an effective treatment strategy has yet to be widely adopted. […] It is well established that surgical treatments of cervical intra-epithelial neoplasia (CIN) predispose women to preterm birth in subsequent pregnancies, including early preterm birth. […] The discovery and introduction of a vaccine to prevent HPV infection can now be expected to dramatically reduce the prevalence of pre-invasive abnormalities of the cervix and hence decrease the need for surgical treatments that may predispose women to subsequent preterm births.

• #64 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  After several decades of research, we now have evidence that at least six interventions are suitable for immediate use in contemporary clinical practice within high-resource settings and can be expected to safely reduce the rate of preterm birth. These interventions involve strategies to prevent non-medically indicated late preterm birth; use of maternal progesterone supplementation; surgical closure of the cervix with cerclage; prevention of exposure of pregnant women to cigarette smoke; judicious use of fertility treatments; and dedicated preterm birth prevention clinics. […] The widespread use of human papillomavirus vaccination in girls and young women will decrease the need for surgical interventions on the cervix and can be expected to further reduce the risk of early birth. Together, this array of clinical interventions, each based on a substantial body of evidence, is likely to reduce rates of preterm birth and prevent death and disability in large numbers of children. The process begins with an acceptance that early birth is not an inevitable and natural feature of human reproduction. Preventative strategies are now available and need to be applied. The best outcomes may come from developing integrated strategies designed specifically for each health-care environment.

• #65 How To Prevent Preterm Birth – Preterm Alliance

  https://pretermalliance.com.au/mothers-to-be/how-to-prevent-preterm-birth/

  Until quite recently, preterm birth has been considered to be an unavoidable and accidental consequence of pregnancy. Thankfully, those times have changed and preterm birth is now considered to be preventable, at least in a proportion of cases. Several decades of research have provided us with the knowledge to safely lower the rate of preterm birth. […] The following preterm birth prevention interventions will be recommended for application into all clinical practices over the coming years. […] The length of your cervix in mid-pregnancy is a strong predictor of your risk of preterm birth. […] If your cervix is less than 25mm on an internal scan your doctor needs to prescribe natural vaginal progesterone 200mg given as a pessary. This treatment should continue until 36 weeks gestation and is expected to halve the risk of preterm birth.

• #66 Preterm Labor and Preterm Birth Prevention | Duke Health

  https://www.dukehealth.org/treatments/obstetrics-and-gynecology/preterm-labor-and-preterm-birth-prevention

  Pregnant women at risk for preterm birth benefit from the expert care provided by Duke perinatologists. We offer personalized preconception counseling and comprehensive prenatal care that may include medical or surgical interventions intended to prevent preterm birth. Our goal is to improve your chances of carrying your baby to full term so he or she can get a healthy start in life. […] Preventing preterm labor and birth is important for the health of your child. Babies born prematurely (before 37 weeks) can be critically ill at birth and experience lifelong health complications, including cerebral palsy, an eye disease called retinopathy of prematurity, undeveloped lungs, and developmental delays. Many of these issues can be avoided if you seek treatment to prevent preterm birth early in your pregnancy.

• #67 Updated Clinical Guidance for the Use of Progestogen Supplementation for the Prevention of Recurrent Preterm Birth | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2023/04/updated-guidance-use-of-progestogen-supplementation-for-prevention-of-recurrent-preterm-birth

  The results of a meta-analysis and an additional recently published study evaluating vaginal progesterone to prevent recurrent preterm birth found that vaginal progesterone was not associated with a reduction in recurrent preterm birth. […] As a result, ACOGs guidance is updated via this Practice Advisory to recommend that in the setting of a singleton pregnancy with a history of prior spontaneous preterm birth, and in the absence of a shortened cervix, vaginal progesterone should not be offered as a prevention option. […] Furthermore, the body of evidence does not indicate that vaginal progesterone is effective for the prevention of recurrent preterm birth in singleton pregnancies with a prior preterm birth between 20 and 37 weeks of gestation in the absence of a shortened cervix. […] Preterm birth remains a significant public health issue and more evidence for effective interventions is urgently needed.

• #68 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  After several decades of research, we now have evidence that at least six interventions are suitable for immediate use in contemporary clinical practice within high-resource settings and can be expected to safely reduce the rate of preterm birth. These interventions involve strategies to prevent non-medically indicated late preterm birth; use of maternal progesterone supplementation; surgical closure of the cervix with cerclage; prevention of exposure of pregnant women to cigarette smoke; judicious use of fertility treatments; and dedicated preterm birth prevention clinics. […] The widespread use of human papillomavirus vaccination in girls and young women will decrease the need for surgical interventions on the cervix and can be expected to further reduce the risk of early birth. Together, this array of clinical interventions, each based on a substantial body of evidence, is likely to reduce rates of preterm birth and prevent death and disability in large numbers of children. The process begins with an acceptance that early birth is not an inevitable and natural feature of human reproduction. Preventative strategies are now available and need to be applied. The best outcomes may come from developing integrated strategies designed specifically for each health-care environment.

• #69 Strategies to Prevent Preterm Birth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4237124/

  After several decades of research, we now have evidence that at least six interventions are suitable for immediate use in contemporary clinical practice within high-resource settings and can be expected to safely reduce the rate of preterm birth. These interventions involve strategies to prevent non-medically indicated late preterm birth; use of maternal progesterone supplementation; surgical closure of the cervix with cerclage; prevention of exposure of pregnant women to cigarette smoke; judicious use of fertility treatments; and dedicated preterm birth prevention clinics. […] The widespread use of human papillomavirus vaccination in girls and young women will decrease the need for surgical interventions on the cervix and can be expected to further reduce the risk of early birth. Together, this array of clinical interventions, each based on a substantial body of evidence, is likely to reduce rates of preterm birth and prevent death and disability in large numbers of children. The process begins with an acceptance that early birth is not an inevitable and natural feature of human reproduction. Preventative strategies are now available and need to be applied. The best outcomes may come from developing integrated strategies designed specifically for each health-care environment.

Zobacz więcej