Predicting preterm delivery and lowering very preterm delivery rate.
The chances and quality of survival depend on gestational age at birth. Why has PTD not decreased during the last decade, in spite of all the known risk factors? Perinatal data bases tend to include biomedical risk factors and are assembled and analysed retrospectively. These data should form the basis for prediction, and risk factors such as stress, anxiety, inflammation (leading to elevated CRH with its role in PTD), short cervix etc, should be added when assessed prospectively. The goal is preconception and early prediction in pregnancy. Only with the implementation of efficient intervention will we lengthen pregnancies and lower the VPTD rate. More articles about the PTD and complications of preterm births should be published in the lay press. There is no room for pessimism: if everybody involved would do just a little in the right direction, the result would be enormous. Constant auditing of interventions is necessary. The most difficult to "cure" and most likely to relapse are stress, anxiety and social factors, and discrimination in obtaining basic health care. Long forgotten lessons of compassion with pregnant women have not yet been acknowledged as proven to change VPTD into PTD, but are available at no cost world wide.
Novak-Antolic
Z
Z
Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia. ziva.novak@guest.arnes.si
D005260:Female; D005865:Gestational Age; D017048:Health Care Costs; D006801:Humans; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D012307:Risk Factors; D017524:Slovenia / Q000453:epidemiology