Prevention and not merely prediction of preterm labor and delivery

摘要

cqvip:Different methods have been proposed to screen forpreterm labor and delivery; most of these aim to predict the risk that preterm delivery is going to take place.However, interesting though this knowledge might be,knowing the future is of no use when no changes canbe made. Recent publications have suggested new andexciting modalities to actually diminish the frequencyof preterm birth in patients selected by transvaginalcervical length measurement; these modalities includevaginal progesterone and vaginal pessaries. Althoughpromising, many questions remain to be answered; notleast about the long term outcome for both neonatesand mothers, but also on the eventual introduction ofsuch strategies to the general obstetric population. Oneof the main problems that urgently needs clarificationis how we are going to offer this best of medicine tothose needing it most: deprived and socially isolatedwomen who have the highest risk for preterm laborand delivery, probably not due to any congenital cervical problems, but to a combination of environmental,microbiological and social factors, including transgenerational poverty and deprivation.