From the Research
Preterm labor is a significant contributor to perinatal morbidity and mortality, and its prediction is crucial in obstetrics to enable timely interventions and improve outcomes for vulnerable premature infants. Preterm labor is characterized by the onset of regular uterine contractions leading to cervical changes before 37 weeks of pregnancy. The prediction of preterm labor is important because it allows for early identification of women at risk and enables targeted preventive strategies, such as administration of corticosteroids to accelerate fetal lung maturity, magnesium sulfate for neuroprotection, and tocolytics to delay delivery long enough for these medications to take effect 1.
Risk Assessment and Prediction
Risk assessment typically includes evaluation of cervical length via transvaginal ultrasound (with <25mm indicating increased risk) and fetal fibronectin testing in symptomatic women 1. The biological basis for preterm labor involves complex interactions between maternal, fetal, and placental factors, including inflammation, infection, uterine overdistension, and premature activation of the maternal-fetal hypothalamic-pituitary-adrenal axis. Accurate prediction enables targeted preventive strategies and appropriate resource allocation, potentially improving outcomes for vulnerable premature infants.
Importance of Prediction
The importance of predicting preterm labor cannot be overstated, as preterm birth is a leading cause of neonatal morbidity and mortality worldwide 2, 1. Early identification of women at risk allows for timely interventions, which can significantly improve outcomes for premature infants. The use of transvaginal ultrasound to measure cervical length and fetal fibronectin testing in symptomatic women are recommended for predicting preterm labor 1.
Current Guidelines and Recommendations
Current guidelines recommend screening for preterm labor by transvaginal ultrasound cervical length measurement between 16 and 24 weeks of gestation, and suggest the use of either vaginal progesterone or cervical cerclage for the prevention of preterm labor, based on specific indications 1. The American College of Obstetricians and Gynecologists, and the European Association of Perinatal Medicine highlight the significance of screening for preterm labor and suggest the use of either vaginal progesterone or cervical cerclage for the prevention of preterm labor, based on specific indications 1.