A critical assessment of preterm labor prevention strategies.

Preterm birth is second only to congenital diseases in causing morbidity and mortality in infants. To prevent preterm labor and delivery, a number of strategies have been developed. When choosing a strategy to prevent preterm birth, however, physicians must remember that preterm delivery arises from three separate conditions: iatrogenic preterm labor, premature rupture of membranes, and idiopathic preterm labor. Many of the programs that have been developed focus on patients who are at high risk for iatrogenic preterm birth and premature rupture of membranes, but do not include patients who are likely to experience idiopathic preterm labor. Since idiopathic preterm labor is the most common cause of preterm birth and is the most amenable to early intervention with tocolytic agents, more preterm labor education efforts should be included in prenatal care programs. In addition, further research is needed to delineate which features of preterm birth prevention programs are responsible for the beneficial effects that have been observed.