Which intervention reduces the risk of preterm birth in women with risk factors in developed and developing countries?
The author describes that cervical cerclage, vaginal pessary and cervical pessary of progesterone can be beneficial in preventing preterm births. However, these three modalities are questionable in their effectiveness and how much prolongation of pregnancy is possible?
Blencowe H, Cousens S, Chou D et al. 1, lucidly enumerate the preventive interventions in low and middle income as well as high income countries:
Types of available interventions in prevention of preterm births in different countries are categorized on the basis of income. There are five interventions proposed to be implemented in high income countries which are: smoking cessation, decreasing multiple embryo transfers in the processes of Assisted Reproductive Technologies, reduction of elective labor induction or cesarean sections without medical or obstetric indication, increased administration of progesterone agents, and cervical cerclage.1
In the low and middle income countries, the suggested interventions are: Family planning, prevention and management of Sexually Transmitted infections, use of insecticide treated bed nets and intermittent preventive treatment of malaria, identification and treatment of pre-eclampsia and reduction of physical overload.1 This will hold true for India as well. Antenatal steroid administration in mothers will prevent respiratory distress syndrome (RDS) in preterm babies and obstetric care and antibiotic administration in pre-labor. Premature rupture of membranes (pPROM) has also reduced maternal and neonatal morbidity and mortality. Because of the large magnitude of the problem and the paucity in the number of interventions for prevention of preterm labor, there appears to be a knowledge gap in the causes of preterm labor. There is a need to further determine the causes and strategies for prevention of preterm labor, delivery and babies.
1. Blencowe H, Cousens S, Chou D et al. Born Too Soon: The global epidemiology of 15 million preterm births. Health 2013;10(Suppl 1):S2.
Competing interests: No competing interests