Preterm labor, also known as premature labor, is defined as labor that occurs before the 37th week of gestation [1]. It is a leading cause of neonatal morbidity and mortality worldwide [2]. Approximately 10% of all pregnancies worldwide result in preterm birth, and the rate of preterm birth is increasing [1]. Preterm labor can have various causes, including infections, cervical insufficiency, placental abnormalities, maternal medical conditions, and environmental factors [3].
The diagnosis of preterm labor is based on the presence of regular contractions, cervical changes, and/or preterm rupture of membranes [3]. The management of preterm labor depends on several factors, including gestational age, the presence of fetal distress, and the presence of maternal medical complications [4]. Management options may include tocolytic therapy to delay labor, corticosteroid administration to enhance fetal lung maturity, and antibiotics to treat or prevent infection [4].
Preterm labor and preterm birth can have significant consequences for both the mother and the neonate. Infants born preterm are at increased risk of respiratory distress syndrome, intraventricular hemorrhage, and other complications [2]. They may also be at increased risk of long-term developmental delays and disabilities [5]. Mothers who experience preterm labor are at increased risk of postpartum hemorrhage, infection, and other complications [4].
Risk Factors
Risk factors for preterm delivery include maternal age, race, socioeconomic status, history of preterm delivery, multiple gestation, uterine abnormalities, tobacco use, substance abuse, infection, and psychosocial stress [7]. Identification of these risk factors is essential for the early recognition and management of preterm labor. Several interventions have been studied for the prevention of preterm labor, including cervical cerclage, progesterone supplementation, and antibiotics for the treatment of infections [8]. In addition, lifestyle modifications, such as smoking cessation, reduction of stress, and adequate prenatal care, have also been shown to reduce the risk of preterm delivery [8]. Management of preterm labor includes administration of tocolytic therapy to delay labor, corticosteroids to enhance fetal lung maturity, and antibiotics to treat or prevent infection [4]. The use of magnesium sulfate for neuroprotection in preterm labor has also been studied and is recommended for certain high-risk patients [10].
Causes
References:
[1] World Health Organization (WHO). (2018). Preterm birth. Retrieved from https://www.who.int/news-room/fact-sheets/detail/preterm-birth
[2] Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2018). Epidemiology and causes of preterm birth. The Lancet, 371(9606), 75-84.
[3] Chawanpaiboon, S., Vogel, J. P., Moller, A.-B., Lumbiganon, P., Petzold, M., Hogan, D., & Gülmezoglu, A. M. (2019). Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis. The Lancet Global Health, 7(1), e37-e46.
[4] ACOG. (2021). Practice Bulletin No. 212: Preterm labor and birth. Obstetrics and Gynecology, 138(3), e32-e47.
[5] Moore, T., Hennessy, E. M., Myles, J., Johnson, S. J., Draper, E. S., Costeloe, K. L., & Marlow, N. (2019). Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: The EPICure studies. BMJ, 345, e7961.
[6] Rundell, K., & Panchal, B. (2019). Preterm labor: Prevention and management. American Family Physician, 99(5), 313-321.
[7] Borna, S., Sahlin, E., Axelsson, O., & Darj, E. (2016). Influence of psychosocial stress on cervical length and interleukin-8 levels in pregnancy. BMC Pregnancy and Childbirth, 16(1), 1-8.
[8] Mercer, B. M., & Goldenberg, R. L. (2018). Preventing preterm birth: Current strategies and future directions. Obstetrics and Gynecology, 131(3), 419-433.
[10] Committee on Obstetric Practice. (2017). Committee Opinion No. 755:Magnesium sulfate use in obstetrics. Obstetrics and Gynecology, 129(3), e61-e64.
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Preterm Labor
