PRETERM BIRTH SURVEILLANCE AND PREVENTION PROGRAM

 

     Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization. In the United States, approximately 12% (13.1% in the state of Arkansas) of all live births occur before term (37 weeks), and preterm labor preceded approximately 50% of these preterm births. Although the causes of preterm labor are not well understood, the burden of preterm births is clear – preterm births account for approximately 70% of neonatal deaths and 36% of infant deaths as well as 25-50% of cases of long-term neurologic impairment in children.

 

     One way to combat the complications of a premature delivery is early recognition of those pregnancies at highest risk for preterm delivery. Early recognition affords the opportunity to be prepared for, and sometimes prevent, premature delivery. Multiple studies have shown that transvaginal ultrasound measurement of the lower segment of the womb (an area called the cervix) can help identify women at risk of delivering early. In addition, the presence of special proteins in vaginal fluid secretions (a substance call fetal fibronectin) can also pinpoint those pregnancies at risk of early delivery.

 

We utilize innovative cervical length surveillance protocols, along with periodic fetal fibronectin screening, to help identify those women at risk for preterm labor. We measure the cervix with high-definition transvaginal ultrasound every two weeks from 16 to 28 weeks of pregnancy and perform fetal fibronectin screening on all women with signs and symptoms of preterm labor. If shortening of the cervix is identified or if fetal fibronectin is detected, multiple interventions, including steroid administration, administration of anti-contraction medications and even surgical stitching of the uterus (a procedure called a cerclage) may be employed to prevent early delivery.

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