Preventing preterm birth: what works, what doesn't.
Preterm birth is one of the most important problems in medicine today with an alarming frequency and economic impact. This paper reviews recent research findings specifically addressing the following primary and secondary prevention interventions: cerclage placement, detection and treatment of infections, progesterone administration, antibiotics in preterm labor and the use of tocolysis. The effectiveness of these interventions is presented in terms of the number needed to treat and number needed to harm. At the present, most of our interventions fail to demonstrate benefit in terms of prevention of preterm birth and improvement of neonatal outcomes. Use of progesterone may hold promise, but whether we will develop effective interventions to reduce risks for all women remains to be seen.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians


OBJECTIVE
After completion of this article, the reader should be able to summarize the epidemiology of preterm births in the U.S., to outline the primary preventive measures for preterm birth, and to interpret the relative effectiveness of the various preventive measures.
Hollier
Lisa M
LM
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Houston Medical School, 5656 Kelley Street, Houston, TX 77026, USA. Lisa.m.hollier@uth.tmc.edu
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023802:Cerclage, Cervical; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis* / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000517:prevention & control*; D011374:Progesterone / Q000627:therapeutic use; D015149:Tocolytic Agents / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D015149:Tocolytic Agents; D011374:Progesterone