By taking a detailed obstetrical history and by transvaginal ultrasound measurement of cervical length, an individual woman’s risk of
preterm birth (PTB) can be very accurately estimated. For those women who are at increased risk there are several interventions that can help prevent preterm birth. Simple things should not be forgotten. Excellent nutrition, good hydration, and increased rest will all reduce contraction frequency and is generally believed to help prevent the occurrence of preterm labor. For women at very high risk or who have already had preterm labor once, a home uterine activity device can identify increasing uterine contractility earlier than the woman can herself. It is controversial whether the reduction in PTB is a result of the monitoring device or the associated daily nursing contact. The fact remains, however, that increased surveillance of these high risk pregnancies will reduce their risk of delivering prematurely. For those women who do develop preterm labor, there are several drugs that can be used to prevent PTB (tocolytic drugs). In most cases, these drugs are more likely to modestly prolong pregnancy than they are to take a woman to term. However, even prolonging pregnancy by only a few days or a week can significantly improve outcomes. Giving antenatal corticosteroids and magnesium sulfate to a woman in preterm labor will reduce her child’s risk of respiratory distress syndrome, intracranial hemorrhage, cerebral palsy, and mortality by almost 50%. Finally, for women with a prior singleton PTB, a new treatment using weekly injections of 17-Alphahydroxy progesterone caproate (aka 17-P) prevents recurrent PTB in 40-50% of cases.
by:
Roger Newman, M.D.
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