Prevention of Premature Birth
By R.L. Goldenberg and D.J. Rouse, New England Journal of Medicine 1998; 339:313-320.
This overview summarizes the results of obstetric interventions for prevention of preterm birth. While some specific interventions have been effective for some women, large-scale interventions have not yet been successful.
“Preterm birth, which occurs in 11 percent of all pregnancies, is responsible for the majority of neonatal deaths and nearly one half of all cases of congenital neurologic disability, including cerebral palsy. Although all births before 37 weeks of gestation are considered premature, births before 32 weeks gestation (2 percent of all births) account for most neonatal deaths and disorders. State and national vital statistics indicate that the incidence of preterm birth has risen over the past 15 years, and it remains twice as high among black women as among white women.
“Most interventions designed to prevent preterm birth …, including treatment of urinary tract infection, cerclage, and treatment of bacterial vaginosis in high-risk women, are not universally effective and are applicable to only a small percentage of women at risk for preterm birth. A more rational approach to intervention will require a better understanding of the mechanisms leading to preterm birth.”
The full text of this article is available online to subscribers of the New England Journal of Medicine.
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