Management of women with a previous preterm birth

Preterm birth (PTB) is the principal cause of perinatal morbidity and mortality of non-anomalous fetuses. It poses major health economic burdens on families and society. Extreme PTB is associated with a high risk of long-term ill-health and disability. Although advances in neonatal care and use of antenatal corticosteroids have improved the survival of preterm babies over the last two decades, the incidence of PTB and its long-term sequelae remain relatively unchanged. Recent strategies for identifying women at risk of PTB include ultrasound assessment of the cervix and the detection of fetal fibronectin on genital swabbing. Progestogen therapy in women at risk may prolong gestation and improve neonatal outcomes, but the optimal regimen and the women most suitable for this therapy remain to be clarified. Further work is required to identify screening methods with high positive predictive values, and to formulate effective therapies that substantially prolong gestation and minimise the proportion of extremely premature births.