Prepregnancy counseling: preterm birth

Preterm birth is a major obstetric problem and accounts for the single most important cause of perinatal mortality in developed countries. Prevention and management of preterm delivery is difficult because it is still not known what initiates the spontaneous inset of labor in women. Recurrence of preterm birth is increased when the first delivery was preterm. This paper analyses risk factors for recurrence of preterm birth and its management. Most efforts to prevent preterm delivery have not been effective because the underlying pathophysiology is not understood. Development of tests that can predict beforehand an impending preterm labor is important in order to optimise the fetus for life extra-uterine. Preventive measurements that could be taken in order to decrease the risk of recurrent preterm delivery are: prevention of multiple gestation with assisted reproductive techniques; stop smoking and drinking alcohol during pregnancy; stop using drugs (e.g. cocaine, marihuana, etc.); regular prenatal care visits with transvaginal sonographic follow-up of the cervix; performing secondary cerclage when a short cervix is found due to cervical incompetence; performing tertiary cerclage when there is dilatation of the internal cervical os with exposure of the membranes; screening and treatment of asymptomatic bacteruria; treatment of maternal diseases before pregnancy; and screening and treatment of bacterial vaginosis in high-risk pregnancies for preterm delivery.