Prediction and Prevention of Preterm Birth

Preterm birth rates of 5 % to 11 % in western industrialized countries reflect a persisting obstetrical problem. Prematurity is the leading cause of perinatal morbidity and mortality. Sequelae in infants can be severe with lifelong health impact. No single cause accounts for prematurity, but rather a variety of different and, in part, interacting reasons lead to the, preterm birth syndrome'. Little is known about the causes of preterm birth. Although infections have been identified as important, different mechanisms in the pathogenesis remain unclear. Preterm labor and preterm premature rupture of membranes leading to spontaneous preterm birth account for 75 % of prematurity, whereas 25 % is related to iatrogenic preterm delivery. Iatrogenic preterm birth may be due to various maternal causes leading to reduced maternal and/or fetal health. Some promotors of preterm birth syndrome are identified, and different factors appear to be protective. Certain maternal disease, lifestyle and nutrition are accessible to early interventions which may prolong a future pregnancy. Patient's history can identify pregnancies at high risk for preterm birth. Systematic adaption of evidence - based techniques for detection (vaginal Cervix ultrasound) and prevention (progesterone therapy) allow for reduction of preterm birth. After onset of the sequence leading to spontaneous preterm birth, tocolytics may mostly delay delivery for 48 hours, only. Systematic use of RDS - prophylaxis and early patient transfer to a perinatal center may reduce perinatal mortality and morbidity by 50 %. However, many sequelae remain. Prevention of preterm birth by systematic use of known options in preconception care hold promise to reduce preterm birth.