Preterm delivery: an overview

Abstract

Preterm delivery is the leading factor causing neonatal mortality and morbidity. We have conducted a PubMed literature search to obtain an update on the etiology, diagnostic problems and therapeutic considerations of preterm delivery. Approximately 5-10% of all births are premature. Preterm labor is associated with preterm rupture of membranes, cervical incompetence, polyhydramnion, fetal and uterine anomalies, infections, social factors, stress, smoking, heavy work and other risk factors. The diagnosis is made on the patients presenting symptoms, clinical findings and of progressive effacement and dilatation of the cervix. Biochemical markers of preterm delivery are of minor importance in daily clinical work. Measurement of the cervix, however, is a practical and valuable tool to predict preterm delivery. Cervical cerclage can be useful in selected cases. Antibiotics may help to prevent preterm labor in cases of known etiologic agents (e.g. preterm rupture of membranes and urinary infection). The use of tocolytic agents such as beta-sympathetic receptor stimulators can be advocated for a few days. There is evidence that their long-term use is not beneficial and could even be harmful to the fetus. Calcium channel blockers (nifedipine) and a new selective oxytocin receptor antagonist, atosiban, appear to be as effective as beta-sympathomimetic drugs on uterine contractions with fewer side-effects. Prostaglandin synthetase inhibitors such as indomethacin may prevent uterine contractions and can be used prior to the 32nd week of pregnancy. A single course of corticosteroid treatment in two doses of 12 mg betamethasone or 6 mg of dexamethasone is important for the prevention of respiratory distress between the 24th and 34th weeks of pregnancy. Multiple doses may be harmful and should be avoided. In these cases management should depend on gestation age (fetal maturity). Uterine contractions after 34 weeks' gestation are not an indication for tocolytic treatment.

Intervention based on BASNEF model increases exclusive breastfeeding in preterm infants in Iran: a randomized controlled trial

“…Infants born alive before complete 37 weeks since the first day of the last menstrual period are called preterm [1]. Unfortunately, despite all the comprehensive attempts for preventing preterm labor and the birth of preterm infants, the rate is still high.…”

Is there any association between periodontitis and preterm low birth weight?

“…PLBW appears to have a multifactorial aetiology, reflecting a combination of genetic, environmental and social factors. Among the maternal risk factors possibly involved in well established PLBW, a few are: age (teenager or older than 36); African-American race/ethnicity; low socioeconomic status and high stress levels; low body weight gain during pregnancy; previous history of PTB, spontaneous abortion and stillbirth; multiple pregnancies; cigarette smoking during pregnancy; alcohol use; generalised or local (cervico-vaginal) infections [3][4][5][6][7][8][9]. Despite this increased knowledge, from 25 to 50% of LBW cases still have an unexplained aetiology and accurate prediction and prevention of this condition remain elusive.…”

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“…Preterm delivery is the leading factor causing neonatal mortality and morbidity [54]. An increased knowledge of the factors regulating the cervical ripening process will give tools for developing pharmaceuticals that can regulate cervical ripening.…”