Towards improved neonatal outcome: future strategies.
The role of the obstetrician is to help predict and prevent maternal/fetal infection/inflammation related to neonatal mortality and morbidity. Predictive studies have mainly focused on the high-risk phenotype. Currently, there is a scientific drive to analyse the genetic susceptibility of preterm birth (PTB). Studies of the combination of environmental and lifestyle risk factors with the known genotype may result in a better understanding of the causation of PTB. Predictive technical markers such as fibronectin, cervical length measurement and home uterine activity remain largely unproven. Current antenatal care has not achieved primary prevention of PTB. Tocolytics and antibiotics constitute the two key elements of secondary prevention. Tocolytics have a minimal benefit but should not be used to prolong an infected preterm pregnancy. The use of antibiotics in preterm premature rupture of membranes can prolong the pregnancy with a decrease in neonatal morbidity. Anti-inflammatory cytokines, cytokine inhibitors and soluble cytokine receptors are promising treatment options that could modulate the intra-amniotic inflammatory process.
Logghe
H
H
Academic Unit of Obstetrics and Gynaecology, Clarendon Wing D-Floor, Leeds General Infirmary, Leeds LS2 9NS, UK. hilde.logghe@lth.nhs.uk
Walker
J J
JJ
D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*