title: The effectiveness of medical interventions aimed at preventing preterm birth: a literature review.
abstract: BACKGROUND
  Preterm birth is a significant global health problem with serious short and long term consequences. This paper reviews the research literature to answer the question how effective are the medical interventions that aim to reduce the rates of preterm birth?
  
  
  METHODS
  A systematic search was carried out in CINAHL, Cochrane, Medline and Embase in relation to following medical treatments aimed at preventing preterm births: anti-infective medications, tocolytics, progesterone and cervical cerclage. The research underpinning each type of intervention is critically analysed in order to establish the validity of knowledge claims that are made for each type of intervention.
  
  
  RESULTS
  In relation to reducing the rates of preterm births, anti-infectives are only effective in the presence of known infection. Screening for infections during pregnancy is ineffective. Tocolytic agents are not effective in decreasing the preterm birth rates. Progesterone seems to be effective in a select group of pregnant women at higher risk of preterm birth. Cervical cerclage plays a small and an occasional role in preventing some preterm births.
  
  
  CONCLUSIONS
  This literature review demonstrates that medical interventions aimed at preventing, not just delaying, preterm birth, are not effective at a population level. Providing holistic, antenatal midwifery care for women living in socio-economic disadvantage and/or with an increased risk of preterm birth seems to be a promising strategy to address the negative effects of the social determinants of disease and thus to reduce the rate of preterm births at an individual and a population level.
authors.affiliation: School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. c3053421@uon.edu.au
authors.forename: Peeranan
authors.initials: P
authors.lastname: Wisanskoonwong
authors.forename: Kathleen
authors.initials: K
authors.lastname: Fahy
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hastie
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D023802:Cerclage, Cervical; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D047928:Premature Birth / Q000517:prevention & control*; D011374:Progesterone / Q000627:therapeutic use*; D015149:Tocolytic Agents / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015149:Tocolytic Agents; D011374:Progesterone