Preterm labour: an open problem in XXI century

Abstract

Preterm labour (PL) is a relevant problem in maternal and child healthcare displaying a persistent trend. The risk of death is 25–35 times higher in premature infants than in normal children, whilst PL-associated stillbirth is 8–13 times more frequent over term labours. Severity of complications with prematurity is inversely proportional to the term of gestation. In general, PLs account for up to 70% of perinatal mortality. At the last FIGO Congress in 2018, PL was identified as an unsolved problem with no current treatment. Lack of scientific grounds for the PL aetiology and pathogenesis precludes practical success alike in prevention and treatment of this complication of pregnancy. In the bottom line, the past 60 years have not witnessed a global decline in the PL rate, it reaches to 9.5% of total births (with a slight variation depending on national commonwealth), and 15m premature infants are born annually. Two challenges currently face improvement of the PL perinatal outcomes: understanding the mechanism of PL and developing a strategy to render support at each stage of medical care to postpone, prevent the distress syndrome and sustain the foetus. The article tackles major issues in the diagnosis, treatment and prevention of preterm labour, aside with its impact on neonatal morbidity and mortality.

Keywords

• preterm labour
• tocolysis
• neonatal mortality
• retinopathy in prematurity
• cervical insufficiency
• prenatal amniotic fluid
• foetal extraction in whole foetal bladder