title: Prevention of preterm delivery: current challenges and future prospects.
abstract: Preterm birth (PTB), defined as delivery at <37 weeks of gestation, is the most important cause of neonatal morbidity and mortality. Therefore, preventing PTB is one of the main goals in obstetric care. In this review, we provide an overview of the current available literature on screening for risk factors for PTB and a summary of preventive strategies in both low-risk and high-risk women with singleton or multiple gestations. Furthermore, current challenges and future prospects on PTB are discussed. For an optimal prevention of PTB, risk stratification should be based on a combination of (maternal) risk factors, obstetric history, and screening tools. Cervical length measurements can help identify women at risk. Thereafter, preventive strategies such as progesterone, pessaries, and cerclage may help prevent PTB. Effective screening and prevention of PTB vary between the different pregnancy populations. In singleton or multiple pregnancies with a short cervix, without previous PTB, a pessary or progesterone might prevent PTB. In women with a (recurrent) PTB in the past, progesterone and a cerclage may prevent recurrence. The effect of a pessary in these high-risk women is currently being studied. A strong collaboration between doctors, patients' organizations, pharmaceutical companies, and (international) governments is needed to reduce the morbidity and mortality as a result of spontaneous PTB.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Maud D
authors.initials: MD
authors.lastname: van Zijl
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Bouchra
authors.initials: B
authors.lastname: Koullali
authors.affiliation: The Robinson Research Institute, School for Reproductive Health and Pediatrics, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Ben Wj
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: Pajkrt
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Oudijk
keywords: current challenges; future prospects; preterm birth; prevention; risk factors