Prevention of Preterm Birth

Jeffrey M. Denney; Jennifer F. Culhane; Robert L. Goldenberg

Disclosures

Women's Health. 2008;4(6):625-638. 

In This Article

Interventions to Improve Outcomes in Infants Who are Born Preterm

Among the interventions that ameliorate prematurity-associated morbidity and mortality, the most successful is regionalization of perinatal care - organizing a system of care so that infants destined to be born preterm are delivered in a labor ward with an adjacent newborn intensive care unit with appropriate facilities and personnel whose training and experience facilitate a good standard of care. Effective antenatal interventions include prophylactic intra-partum antibiotics that reduce neonatal sepsis - especially to cover group B streptococcus - the use of antenatal steroids to accelerate fetal lung maturation and, finally, prevention as well as prompt management of intra-partum fetal hypoxia.[16,17,18] Effective neonatal management protocols include various methods for mechanical ventilation, antibiotics, judicious fluid and electrolyte management and exogenous-surfactant therapy. As a result of these and other effective interventions, the neonatal mortality of very low birthweight neonates born in the USA and elsewhere in developed countries has decreased significantly. In spite of the dramatically lower mortality rates, approximately 50-60% of all neonatal deaths occur in the 1-2% of all infants who are born weighing less than 1 kg.[19] Oddly, the improvement in survival has not been associated with a concomitant reduction in risk of prematurity-associated neurologic handicaps.[20]

Antenatal steroids are one of the most effective tools in the hands of the obstetrician to prevent or reduce associated morbidity and mortality of preterm birth. An NIH consensus conference recommended the use of corticosteroids in pregnant women between 24 and 34 weeks' gestational age who are at risk for preterm delivery within 7 days; conditions meeting such criteria include diagnoses of preterm labor, pPROM, severe pre-eclampsia necessitating preterm delivery and other maternal-fetal indications.[21] In fact, recent data suggest that as early as 23 weeks gestation, a complete course of antenatal steroids is associated with an 82% reduction in the risk of neonatal death.[22] The American College of Obstetricians and Gynecologists (ACOG) recommends using either β-methasone or dexamethasone since they are both extensively studied and widely used to affect antenatal fetal organ maturation.[23] However, several studies suggest that there may be less morbidity and mortality with β-methasone; specifically, recently published data associate use of dexamethasone with increased risk for intraventricular hemorrhage, retinopathy of prematurity and neonatal death.[24,25]

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