Primary prevention
Pre-conception interventions to decrease the risk of preterm birth:
Those directed to aid in the overall health of the mother (maternal lifestyle modification) through education, with an emphasis on general health improvement, smoking cessation, appropriate activity, and exercise.
Adequate nutrition and antenatal/perinatal supplements (e.g., folic acid, iron) to help foster a healthy pre-pregnancy lifestyle.
Improving public awareness of this condition and thereby increasing rates of antenatal care, with a description of the impact of preterm birth as the leading cause of infant mortality, despite modern intensive care.
Maternal medical, family, and social history, coupled with a thorough physical examination prior to conception, can identify many of the risk factors for premature birth in women, and allows for early intervention or, at least, preparation for non-modifiable factors.[19]
Maternal age at delivery of 35 years and older is associated with adverse maternal, fetal, and neonatal outcomes. The American College of Obstetricians and Gynecologists recommends that patients are suitably counselled regarding this risk and that this is taken into consideration when formulating management plans.[13]
Interventions to decrease the risk of preterm birth post-conception:[20]
Antenatal care visits, provide a crucial opportunity for early identification of maternal risk factors that increase the risk for a premature birth.[19] Knowledge of a previous premature delivery is mandatory.
Assessment of maternal serology status, including hepatitis B, hepatitis C, HIV, rubella and syphilis.[21]
Antenatal progesterone therapy has shown benefit in preventing preterm delivery in individuals with a prior preterm birth or where there is a short cervix.[8][22]
Treatment of bacterial vaginosis in women at higher risk of preterm delivery has been investigated, but the evidence is inconclusive.[23]
Prophylactic cervical cerclage decreases the risk of preterm birth in women at high risk for preterm birth.[24]
Fetal ultrasound can be used to accurately assess gestational age, and allows for early identification of fetal anomalies that may increase the risk for, or necessitate, preterm birth.
Screening with maternal blood tests and fetal ultrasound to identify pregnancies at higher risk of trisomy.
Interventions to decrease the risk of preterm birth post-preterm labour:
Optimal perinatal management, including the use of tocolytics such as calcium-channel blockers, oxytocin receptor antagonists, beta mimetics, and prostaglandin inhibitors, may be beneficial in stopping contractions after onset of preterm labour.[25][26]
Antibiotic treatment after preterm premature rupture of membranes reduces the risk of birth within the subsequent 48 hours.[27]
Secondary prevention
Management of acute medical problems commonly associated with premature birth should be addressed in consultation with a neonatologist after successful resuscitation and stabilisation. The degree of prematurity, in most cases, directly correlates with the extent and severity of acute medical conditions. Optimal perinatal management may improve outcomes for premature infants.
Antenatal corticosteroid administration reduces the incidence and severity of neonatal respiratory distress syndrome; it should be considered for women with a high likelihood of delivery (within 7 days) between 22 and 24 weeks' gestation and is recommended for women likely to deliver between 24 and 34 weeks’ gestation.[119][169]
Excessive oxygen exposure (100%) should be avoided, to reduce the likelihood of subsequent complications such as retinopathy of prematurity (ROP) or chronic lung disease. This should be followed by ophthalmology assessment for early identification of ROP as recommended by the American Academy of Pediatrics, based on birth weight and gestational age.[153]
Early intervention programmes (e.g., developmental assessment) in conjunction with occupational therapy/physiotherapy and neuroimaging such as magnetic resonance imaging help evaluate for white matter injury associated with prematurity and aid in optimising the development of the child.[170][171]
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Administration of magnesium sulfate to women at risk of preterm delivery significantly reduces the risk of cerebral palsy and motor disorders in childhood, without increasing the risk of death.[172][173]
High-quality evidence suggests that delayed cord clamping of 30 to 120 seconds decreases hospital mortality by 32% in preterm infants.[174]
Maintenance of adequate nutrition is important in those with poor growth, to prevent complications such as faltering growth and short stature; there are data that good nutrition improves overall outcomes in premature neonates.[175]
Preterm infants of African American heritage are the ethnic group most likely to suffer from the structure and processes of neonatal care, and have poor outcomes. The picture is complicated and more research is needed.[176]
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