title: Antepartum and intrapartum interventions to prevent preterm birth and its sequelae.
abstract: Preterm birth is the main cause of neonatal morbidity and mortality. This review provides an overview of antepartum and intrapartum management of threatened preterm birth. The most effective method to identify women at high risk of delivering within seven days is the combination of cervical length and fetal fibronectin test. Antenatal corticosteroids administered for 48 h improve neonatal outcome. Although tocolysis has been shown to prolong pregnancy, there is no evidence that tocolytic therapy improves neonatal outcomes. Intrapartum administration of magnesium sulfate improves neurologic outcomes, such as cerebral palsy and gross motor function. In women with preterm premature rupture of membranes, prophylactic antibiotic treatment with erythromycin improves short-term neonatal outcomes, but proof of long-term benefit is lacking. In threatened preterm birth with intact membranes, prophylactic antibiotic treatment is thought to be harmful. Critical appraisal of the long-term benefits and harms of all these treatments questions their use.
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: T A J
authors.initials: TA
authors.lastname: Nijman
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: E O G
authors.initials: EO
authors.lastname: van Vliet
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Koullali
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.a.oudijk@amc.uva.nl.
authors.forename: M A
authors.initials: MA
authors.lastname: Oudijk
mesh_terms: D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D018743:Perinatal Care / Q000639:trends; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D011295:Prenatal Care / Q000639:trends; D011296:Prenatal Diagnosis; D012306:Risk
keywords: Antenatal corticosteroids; Neonatal outcome; Neuroprotection; Preterm birth; Tocolysis