Preterm birth prevention: A Quick Review
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Preterm birth (PTB) is a major public health problem with high neonatal morbidity and mortality. Neonatal mortality and morbidity are related to the gestational age of delivery: the earlier the birth, the higher the morbidity and mortality.

Cervical length (CL) measured by transvaginal ultrasound at 20–24 weeks is a reliable test to identify pregnancy with a higher risk for spontaneous preterm birth. The risk of Preterm birth is inversely related to the length of the cervix: about 0.2% at 60 mm to 1.1% at 25 mm, 4.0% at 15 mm, and 78% at 5 mm

Natural progesterone halves the risk of preterm birth in singleton pregnant women with a short cervical length. In singleton pregnancy with mid-gestation ultrasound short Cervical length, vaginal progesterone is associated with a statistically significant reduction in the risk of respiratory distress syndrome, low birth weight, very low birth weight, and less admission to the neonatal intensive care unit.

In twin-pregnant women with a Cervical length less than 25 mm, vaginal progesterone might be associated with the reduction of preterm birth and neonatal morbidity including a reduction in the risk of respiratory distress syndrome, neonatal and perinatal death, very low birth weight, and also less need for mechanical ventilation. However, RCT is needed to confirm these findings. However, in twin-pregnant women with a Cervical length greater than or equal to 30 mm, vaginal progesterone seems to increase the risk of spontaneous birth before 32 weeks. In pregnant women with an (a) singleton gestation, (b) prior spontaneous preterm birth, and (c) a sonographic short cervix less than 25 mm, both vaginal progesterone and cerclage are equally efficacious on preterm birth prevention and on the improvement of adverse perinatal outcomes. Nevertheless, the treatment selection should be based on adverse events and cost-effectiveness, and patient/physician's choice.

Source:https://www.sciencedirect.com/science/article/pii/S1521693420301425
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