Feto-Maternal Centre, AL Markhyia, Doha, Qatar.
Professor of Obstetrics and Gynecology, Weill Cornell Medicine, Qatar.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2183756. doi: 10.1080/14767058.2023.2183756.
Spontaneous preterm birth (delivery before 37 completed weeks) is the single most important cause of perinatal morbidity and mortality. The rate is increasing world-wide with a great disparity between low, middle and high income countries. It has been estimated that the cost of neonatal care for preterm babies is more than 4 times that of a term neonate admitted into the neonatal care. Furthermore, there are high costs associated with long-term morbidity in those who survive the neonatal period. Interventions to stop delivery once preterm labor starts are largely ineffective hence the best approach to reducing the rate and consequences is prevention. This is either primary (reducing or minimizing factors associated with preterm birth prior to and during pregnancy) or secondary - identification and amelioration (if possible) of factors in pregnancy that are associated with preterm labor. In the first category are optimizing maternal weight, promoting healthy nutrition, smoking cessation, birth spacing, avoidance of adolescent pregnancies and screening for and controlling various medical disorders as well as infections prior to pregnancy. Strategies in pregnancy, include early booking for prenatal care, screening and managing medical disorders and their complications, and identifying predisposing factors to preterm labor such as shortening of the cervix and timely instituting progesterone prophylaxis or cervical cerclage where appropriate. The use of biomarkers such as oncofetal fibronectin, placental alpha-macroglobulin-1 and IGFBP-1 where cervical screening is not available or to diagnosis PPROM would identify those that require close monitoring and allow the institution of antibiotics especially where infection is considered a predisposing factor. Irrespective of the approach to prevention, timing the administration of corticosteroids and where necessary tocolysis and magnesium sulfate are associated with an improved outcome. The role of genetics, infections and probiotics and how these emerging dimensions help in the diagnosis of preterm birth and consequently prevention are exciting and hopefully may identify sub-populations for targeted strategies.
自发性早产（妊娠 37 周前分娩）是围产期发病率和死亡率的最重要原因。在全球范围内，这一比率在低收入、中等收入和高收入国家之间存在巨大差异。据估计，早产儿的新生儿护理费用是足月新生儿的 4 倍以上。此外，那些在新生儿期幸存下来的人长期患病的费用也很高。一旦早产开始，阻止分娩的干预措施在很大程度上是无效的，因此减少早产发生率和后果的最佳方法是预防。这可以是初级预防（在妊娠前和妊娠期间减少或最小化与早产相关的因素）或二级预防——识别和改善（如果可能）与早产相关的妊娠因素。在第一类中，包括优化母体体重、促进健康营养、戒烟、生育间隔、避免青少年怀孕以及在怀孕前筛查和控制各种医学疾病和感染。在怀孕期间的策略包括尽早预约产前保健、筛查和管理医疗疾病及其并发症，以及识别早产的诱发因素，如宫颈缩短，并在适当情况下及时进行孕激素预防或宫颈环扎。使用生物标志物，如oncofetal fibronectin、胎盘α-巨球蛋白-1 和 IGFBP-1，在宫颈筛查不可用或用于诊断 PPROM 时，可以识别需要密切监测的患者，并允许使用抗生素，特别是在感染被认为是诱发因素的情况下。无论预防方法如何，给予皮质类固醇和必要时给予宫缩抑制剂和硫酸镁与改善结局相关。遗传学、感染和益生菌的作用以及这些新兴维度如何有助于早产的诊断，从而有助于预防，这是令人兴奋的，希望能确定针对特定人群的策略。
