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Predicting Premature Delivery—No Easy Task
By C.J. Lockwood, New England Journal of Medicine 2002; 346:282-284.
New strategies are needed for successful prevention of preterm labor and premature delivery. Innovative approaches should include attention to underlying maternal conditions arising quite early in pregnancy, well before the onset of preterm labor. More research is needed to understand these conditions; some will require targeted therapies.
“The prevention of preterm delivery will require intervention at an earlier stage in the processes that lead to it. Strategies are needed to prevent ascending genital tract infections and to reduce excessive cytokine responses to normal genital tract flora. Prophylactic heparin therapy should be rigorously evaluated in women with inherited or acquired thrombophilia who have recurrent premature deliveries due to placental abruptions or uteroplacental thrombosis.
“Finally, since the induction of ovulation and in vitro fertilization are major causes of multifetal gestations, we must refine our assisted reproductive techniques to reduce the occurrence of twin and higher-order multifetal pregnancies. Although several biomarkers are associated with premature delivery, the [recent research] findings … reinforce the conclusion that the practical usefulness of these markers in the case of an individual woman is limited.”
The full text of this article is available online to subscribers of the New England Journal of Medicine.
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