Management of preterm delivery

Preterm deliveries are those that occur at less than 37 weeks' gestational age. It is a pathologic condition with high perinatal morbidity and mortality, because it causes significant short- and long-term sequelae in the newborn. Although the association of preterm birth with certain maternal factors, fetal factors and pregnancy-related factors is now known, the underlying pathophysiological mechanisms are not yet completely understood; however, today the focus is mainly on the role of the immune system. For diagnosis, in clinical practice, ultrasound evaluation of cervical length and fetal fibronectin assay has become crucial. While, more various is the preventive and therapeutic approach, making use of cervical cerclage and tocolytic therapy. Tocolitics have taken an important role to obtain a delay of delivery of at least 24-48 hours, allowing administration of corticosteroids to induce fetal lung maturity and prevent Respiratory Distress Syndrome; and to plan appropriate perinatal support with possible relocation to the Neonatal Intensive Care Unit (NICU). Given the value that assumes the preterm birth on maternal and child health and on health care costs, a constant elaboration of the topic is necessary, in order to arrive at an accurate, correct and safe diagnosis more easily, and avoid unnecessary treatments or treatments without demonstrable benefits. © Copyright 2011, CIC Edizioni Internazionali