Preterm labour and prematurity

Preterm birth occurs as a result of spontaneous preterm labour, in most cases associated with infection/inflammation and preterm pre-labour rupture of membranes. About 1/4 cases are iatrogenic. The incidence of preterm birth continues to increase in both developed and developing countries; most perinatal morbidity and mortality results from preterm births at less than 30 weeks’ gestation. The prediction of spontaneous preterm birth has improved significantly, particularly through the use of transvaginal ultrasonography and fetal fibronectin testing. However, preventive measures such as tocolysis, cervical cerclage, progestogen and antibiotics have made little impact on outcome and require further evidence-based evaluation. In day-to-day clinical practice, interventions are often chosen based on personal preference, poor evidence of efficacy and the need to ‘do something’. Accurate identification of at-risk women and cautious intervention in an evidence-based manner is advocated with careful consideration of the risks and benefits until further information is available to guide management.