Preterm birth prevention

• Published in: Best practice & research. Clinical obstetrics & gynaecology Vol. 69; pp. 40 - 49
• Main Authors: da Fonseca, Eduardo B., Damião, Rievani, Moreira, Daniela Aires
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.11.2020
• Subjects: Preterm birth; Progesterone; Short cervical length; Transvaginal ultrasound; Short cervical length; Transvaginal ultrasound; Preterm birth; Progesterone
• ISSN: 1521-6934; 1532-1932; 1532-1932
• DOI: 10.1016/j.bpobgyn.2020.09.003

Preterm birth (PTB), which occurs in about 12% of pregnancies worldwide, is the main cause of neonatal morbidity and mortality. Symptomatic treatment of pregnancies presenting in preterm labor with corticosteroids and antibiotics has improved neonatal outcomes but has not reduced the incidence of PTB. Evidence suggests that the rate of PTB may be reduced by the prophylactic use of progesterone in women with a previous history of preterm delivery and in those with a short cervical length identified by routine transvaginal ultrasound. This review summarizes the evidence (level A evidence) of the effectiveness of progesterone on the rate of PTB. •Progesterone for singleton and twins presenting with a short cervical length reduces the incidence of PTB.•Progesterone reduces the risk of neonatal morbidity, lower admission and allow shorter length stay in NICU.•Although universal CxL screening is not recommended by some Ob/Gyn Societies, it is seen as reasonable for all of them.•The FIGO Working Group of Best Practice recommended CxL universal screening by mid-trimester transvaginal ultrasonographic.•Progesterone or cerclage are equally effective for singleton pregnant with a prior spontaneous early-PTB, and short cervix.