title: Prevention of spontaneous preterm birth: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF).
abstract: In France, 60,000 neonates are born preterm every year (7.4%), half of them after the spontaneous onset of labor. Among preventable risk factors of spontaneous prematurity, only cessation of smoking is associated with decreased prematurity (level of evidence [LE]1). It is therefore recommended (Grade A). Routine screening and treatment of vaginal bacteriosis is not recommended in the general population (Grade A). The only population for which vaginal progesterone is recommended is that comprising asymptomatic women with singleton pregnancies, no history of preterm delivery, and a short cervix at 16-24 weeks of gestation (Grade B). A history-indicated cerclage is not recommended for women with only a history of conization (Grade C), uterine malformation (professional consensus), isolated history of preterm delivery (Grade B), or twin pregnancies for primary (Grade B) or secondary (Grade C) prevention of preterm birth. A history-indicated cerclage is recommended for a singleton pregnancy with a history of at least 3 late miscarriages or preterm deliveries (Grade A). Ultrasound cervical length screening is recommended between 16 and 22 weeks for women with a singleton previously delivered before 34 weeks gestation, so that cerclage can be offered if cervical length <25mm before 24 weeks (Grade C). A cervical pessary is not recommended for the prevention of preterm birth in a general population of asymptomatic women with twin pregnancies (Grade A) or in populations of asymptomatic women with a short cervix (professional consensus). Although the implementation of universal screening by transvaginal ultrasound for cervical length at 18-24 weeks of gestation in women with a singleton gestation and no history of preterm birth can be considered by individual practitioners, this screening cannot be universally recommended. In cases of preterm labor, (i) it is not possible to recommend any one of the several methods (ultrasound of the cervical length, vaginal examination, or fetal fibronectin assay) over any other to predict preterm birth (Grade B); (ii) routine antibiotic therapy is not recommended (Grade A); (iii) prolonged hospitalization (Grade B) and bed rest (Grade C) are not recommended. Compared with placebo, tocolytics are not associated with a reduction in neonatal mortality or morbidity (LE2) and maternal severe adverse effects may occur with all tocolytics (LE4). Atosiban and nifedipine (Grade B), unlike beta-agonists (Grade C), can be used for tocolysis in spontaneous preterm labor without preterm premature rupture of membranes. Maintenance tocolysis is not recommended (Grade B). Antenatal corticosteroid administration is recommended for all women at risk of preterm delivery before 34 weeks of gestation (Grade A). After 34 weeks, the evidence is insufficiently consistent to justify recommending systematic antenatal corticosteroid treatment (Grade B), but a course of this treatment might be indicated in clinical situations associated with high risk of severe respiratory distress syndrome, mainly in case of planned cesarean delivery (Grade C). Repeated courses of antenatal corticosteroids are not recommended (Grade A). Rescue courses are not recommended (Professional consensus). Magnesium sulfate administration is recommended for women at high risk of imminent preterm birth before 32 weeks (Grade A). Cesareans are not recommended for fetuses in vertex presentation (professional consensus). Both planned vaginal and elective cesarean delivery are possible for breech presentations (professional consensus). Delayed cord clamping may be considered if the neonatal or maternal state allows (professional consensus).
authors.affiliation: Service de Gynécologie-Obstétrique, CHU Bordeaux, Université de Bordeaux, France. Electronic address: loicsentilhes@hotmail.com.
authors.forename: Loïc
authors.initials: L
authors.lastname: Sentilhes
authors.affiliation: Service de Gynécologie-Obstétrique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.
authors.forename: Marie-Victoire
authors.initials: MV
authors.lastname: Sénat
authors.affiliation: Equipe de Recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, Inserm U1153, Bâtiment Port-Royal, 53 avenue de l'Observatoire, 75014 Paris, Université Paris Descartes, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel
authors.affiliation: Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint Joseph, DHU Risque et Grossesse, Université Paris Descartes, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azria
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, Caen, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Benoist
authors.affiliation: AP-HM, Hôpital Nord, Service de Gynécologie-Obstétrique, Gynépôle, Aix-Marseille Université Marseille, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Blanc
authors.affiliation: Hôpital Saint Vincent de Paul, GHICL, FLMM, Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Brabant
authors.affiliation: AP-HM, Hôpital Nord, Service de Gynécologie-Obstétrique, Gynépôle, Aix-Marseille Université Marseille, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
authors.affiliation: Service de Gynécologie-Obstétrique, CHU Bordeaux, Université de Bordeaux, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Brun
authors.affiliation: Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Gynécologie Obstétrique, 59 Boulevard Pinel, 69677 Bron Cedex, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Doret
authors.affiliation: Collectif interassociatif autour de la naissance (CIANE), France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Ducroux-Schouwey
authors.affiliation: Collectif interassociatif autour de la naissance (CIANE), France.
authors.forename: Anne
authors.initials: A
authors.lastname: Evrard
authors.affiliation: Service de Gynécologie-Obstétrique, Hôpital Trousseau, APHP, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
authors.affiliation: Service de Médecine fœtale, Hôpital Trousseau, APHP, Paris, France.
authors.forename: Emeline
authors.initials: E
authors.lastname: Maisonneuve
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Marcellin
authors.affiliation: Service de Pédiatrie néonatale et Réanimation, Neuropédiatrie, Centre de Référence des Troubles des Apprentissages de l'Enfant, CAMSP, Hôpital Charles Nicolle, CHU de Rouen, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Marret
authors.affiliation: Service de Gynécologie-Obstétrique, CHU Hôpital Jean Minjoz, 25030 Besançon Cedex, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mottet
authors.affiliation: Collège National des Sages-Femmes de France, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Paysant
authors.affiliation: Service de Gynécologie-Obstétrique, CHU Hôpital Jean Minjoz, 25030 Besançon Cedex, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Riethmuller
authors.affiliation: Département d'Obstétrique et Gynécologie, Hôpital Poissy-Saint Germain, Université Versailles, St Quentin, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rozenberg
authors.affiliation: AP-HP, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Université Paris Diderot, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitz
authors.affiliation: Equipe de Recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, Inserm U1153, Bâtiment Port-Royal, 53 avenue de l'Observatoire, 75014 Paris, Université Paris Descartes, France.
authors.forename: Héloïse
authors.initials: H
authors.lastname: Torchin
authors.affiliation: Pôle de Gynécologie-Obstétrique, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg, Université de Strasbourg, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Langer
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*
keywords: Cerclage; Cervical pessary; Corticosteroid; Fetal fibronectin; Magnesium sulfate; Preterm birth without preterm premature rupture of membranes; Progesterone; Tocolysis; Ultrasound cervical length