New Perspectives in the Pathways to Preterm Delivery

A. C. Vidaeff

Abstract: Preterm delivery (PTD) is the main cause of neonatal morbidity and mortality in the developed world, generating a significant public health burden. PTD is a complex disorder and it is unlikely that one generalized prevention strategy will be effective in all patients. The purpose of this review is to follow the recent developments in risk identification and prognostication of PTD in connection with appropriately targeted prophylactic interventions. The recent literature has treated PTD prevention focusing exclusively on either progesterone use or cerclage, leaving the practitioner without any guidance on when to proceed with medical or surgical prophylaxis. Understanding that high risk populations are not homogeneous and no single approach modality is likely to be generally applicable, we have combined the available evidence on both progesterone and cerclage to provide guidance on how to identify subgroups of women at significantly in creased risk for PTD and how to preferentially consider progesterone versus cerclage or viceversa.
Keywords: preterm delivery, cerclage, pro ges te rone, prevention