Prevention of Preterm Birth

A Randomized Clinical Trial of Care for Women With Preterm Labour: Home Management Versus Hospital Management

“…A principal goal of obstetric care is the prevention of prematurity. 16 Indeed, the ultimate goal for the treatment of preterm labour is the delivery of a healthy term neonate because it is known that neonatal outcomes are greatly improved when intrauterine life is extended. If fetal status is acceptable, prolonging pregnancy decreases the incidence of several neonatal morbidity factors such as respiratory distress, patent ductus arteriosus, prolonged intensive care and the overall number of days spent in hospital.…”

“…In-hospital management has not been shown to improve perinatal outcomes in the treatment of women with a high-risk singleton pregnancy, 11,13 although there are many proponents of this treatment for women with preterm labour. [14][15][16] Given the rise in health care costs, physicians have been forced to modify medical management by sending women home earlier, often without special follow-up programs. There is a dearth of information on the impact and the safety of early hospital discharge programs for women experiencing preterm labour.…”

“…21 Published reports on alternative approaches to the management of preterm labour focus mostly on the efficacy of ambulatory monitoring of uterine activity, program implementation and home monitoring of uterine activity with or without visits from nurses. 8,16,[22][23][24] Dahlberg 25 and Harmon and Barry 26 have described prenatal home care programs that included home visits by nurses, assessment, teaching, supervision, telephone accessibility and medical referral. The objective of such programs is to provide support and care in the more familiar and less costly home environment.…”

Preterm birth prevention programs A critique of current literature

“…If preterm births caused by PPROM are not the result of uterine activity but rather of nonlabor etiologies such as infection, then prevention efforts will obviously require knowledge and identification of, and an ability to eradicate, factors that cause PPROM. These risk factors may be similar but not identical to those associated with spontaneous preterm labor (30–32). As noted above, intervention strategies to delay birth (such as the use of tocolytic agents) are generally not applied when ruptured membranes are present.…”

The effect of indomethacin tocolysis in preterm labour on perinatal outcome: a randomised placebo‐controlled trial

“…Preterm birth remains a major source of perinatal morbidity and mortality, and preterm labour accounts for the majority of preterm births 1 . Prostaglandins have been shown to have a central role in the genesis of labour at term, and presumably before term 2,3 .…”