Prevention of Preterm Parturition

This article reviews risk factors for preterm delivery, with special attention to previous preterm birth and a short cervix. Strategies for minimizing the risk of preterm birth among high-risk women, including progesterone supplementation and cerclage, are discussed. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage A woman presents for prenatal care in the first trimester of her third pregnancy. Her first child was born at 30 weeks of gestation after preterm labor. Her second pregnancy ended in delivery at 19 weeks of gestation. How would you recommend reducing the risk of preterm birth in this pregnancy? The Clinical Problem In the United States, the annual rate of preterm births (before 37 weeks of gestation) reached a peak of 12.8% in 2006 and was 11.7% in 2011. 1 The rate in the United States remains nearly twice the rate in European nations. 2 Premature birth in the . . .