From the Research
Preterm labor is defined as the onset of regular uterine contractions resulting in cervical changes before 37 weeks of gestation, potentially leading to preterm birth, and it is a critical public health priority due to its significant contribution to neonatal mortality and long-term disability.
Definition and Global Impact
Preterm labor affects approximately 15 million babies annually worldwide, with rates varying significantly between regions, from 5-7% in some European countries to 15-18% in parts of Africa and South Asia 1. The United States has a preterm birth rate of about 10% 2.
Epidemiology
The epidemiology of preterm labor is complex, involving multiple factors including previous preterm birth, multiple gestation, cervical insufficiency, uterine anomalies, infection, and socioeconomic factors 3. Understanding these factors is crucial for developing effective prevention and management strategies.
Maternal-Fetal Risks
Preterm labor carries substantial risks for both mother and baby, including increased likelihood of cesarean delivery, postpartum hemorrhage, and psychological distress for the mother, and respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, and long-term neurodevelopmental impairments for the fetus and newborn 4.
Prevention Strategies
Prevention strategies may include progesterone supplementation (200mg vaginal progesterone daily or 250mg 17-hydroxyprogesterone caproate weekly injections) for women with prior preterm birth or short cervix, and cervical cerclage in selected cases 5. The choice of tocolytic agent, such as magnesium sulfate, beta-agonists, nifedipine, or atosiban, depends on the clinical scenario and the balance between efficacy and safety 5. Key points to consider in managing preterm labor include:
- Accurate diagnosis and assessment of gestational age and fetal well-being
- Identification of risk factors and underlying causes of preterm labor
- Appropriate use of tocolytic agents and other interventions to delay or prevent preterm birth
- Consideration of fetal and maternal risks and benefits in decision-making
- Development of comprehensive prevention and management approaches to reduce the global burden of preterm birth.