Prevention of preterm birth | Randomized trials | Research (2023)

The majority of babies born prematurely survive and develop normally. However, babies born before 34 weeks have a higher chance of dying soon after birth or becoming disabled than babies born at term. In singleton pregnancies the chance that a woman will go into labour and deliver before 34 weeks is about 1%. In twin pregnancies, the chance of such premature birth is 10-15%.

Vaginal progesterone in singletons

Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH; Fetal Medicine Foundation Second Trimester Screening Group. Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med 2007;357:462-9.

Previous randomized trials had shown that progesterone administration in women who previously delivered prematurely reduces the risk of recurrent premature delivery. Asymptomatic women found at midgestation to have a short cervix are at greatly increased risk for spontaneous early preterm delivery, and it was unknown whether progesterone reduces this risk in such women.

(Video) Preventing Preterm Births | Cincinnati Children's

In this study, cervical length was measured by transvaginal ultrasonography at a median of 22 weeks of gestation (range, 20 to 25) in 24,620 pregnant women seen for routine prenatal care. Cervical length was 15 mm or less in 413 of the women (1.7%), and 250 (60.5%) of these 413 women were randomly assigned to receive vaginal progesterone (200 mg each night) or placebo from 24 to 34 weeks of gestation. The primary outcome was spontaneous delivery before 34 weeks. Spontaneous delivery before 34 weeks of gestation was less frequent in the progesterone group than in the placebo group (19.2% vs. 34.4%; relative risk, 0.56; 95% confidence interval [CI], 0.36 to 0.86). Progesterone was associated with a nonsignificant reduction in neonatal morbidity (8.1% vs. 13.8%; relative risk, 0.59; 95% CI, 0.26 to 1.25; P=0.17). There were no serious adverse events associated with the use of progesterone.

It was concluded that in women with a short cervix, treatment with progesterone reduces the rate of spontaneous early preterm birth.

A meta-analysis, which included the above and four other similar trials in singleton pregnancies, was carried out by Romero R, Nicolaides KH, Conde-Agudelo A, O'Brien JM, Cetingoz E, Da Fonseca E, Creasy GW, Hassan SS(an updated meta-analysis including data from the OPPTIMUM study. Ultrasound Obstet Gynecol2016;48:308-17). The study showed that vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix. The study assessed the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a singleton gestation and a sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester. Data were available for 974 women. Vaginal progesterone, compared with placebo/no treatment, was associated with a statistically significant reduction in the risk of preterm birth occurring at < 28 to < 36 gestational weeks (RRs from 0.51 to 0.79), composite neonatal morbidity and mortality (RR, 0.59, 95% CI, 0.38-0.91) and some measures of neonatal morbidity, without any demonstrable deleterious effects on childhood neurodevelopment.

A meta-analysis of individual participant data, which included the above and five other similar trials in twin pregnancies, was carried out by Romero R, Conde-Agudelo A, El-Refaie W, Rode L, Brizot ML, Cetingoz E, Serra V, Da Fonseca E, Abdelhafez MS, Tabor A, Perales A, Hassan SS, Nicolaides KH (vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol 2017;49:303-314). The study assessed the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a twin gestation and a sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester. Data were available for 303 women (159 assigned to vaginal progesterone and 144 assigned to placebo/no treatment) and their 606 fetuses/infants. Vaginal progesterone, compared with placebo/no treatment, was associated with a significant reduction in the risk of preterm birth occurring at < 30 to < 35 gestational weeks, neonatal mortality and some measures of neonatal morbidity, without any demonstrable deleterious effects on childhood neurodevelopment.

Vaginal progesterone in twins

Rehal A, Benkő Z, De Paco Matallana C, Syngelaki A, Janga D, Cicero S, Akolekar R, Singh M, Chaveeva P, Burgos J, Molina FS, Savvidou M, De La Calle M, Persico N, Quezada Rojas MS, Sau A, Greco E, O’Gorman N, Plasencia W, Pereira S, Jani JC, Valino N, Del Mar Gil M, Maclagan K, Wright A, Wright D, Nicolaides KH. Early vaginal progesterone versus placebo in twin pregnancies for the prevention of spontaneous preterm birth: a randomized, double-blind trial. Am J Obstet Gynecol 2021;224:86.e1-86.e19.

(Video) Preventing preterm births: 5 warning signs of preterm birth

Trials in unselected twin pregnancies had reported that vaginal administration of progesterone from mid gestation had no significant effect on the incidence of early preterm birth. Such apparent lack of effectiveness of progesterone in twins may be due to inadequate dosage or treatment that is started too late in pregnancy. In this trial it was hypothesized that among women with twin pregnancies, vaginal progesterone at a dose of 600 mg per day from 11 to 14 until 34 weeks' gestation, as compared with placebo, would result in a significant reduction in the incidence of spontaneous preterm birth between 24+0and 33+6weeks.

In this trial, which was conducted at 22 hospitals in England, Spain, Bulgaria, Italy, Belgium, and France, 582 women were assigned to the progesterone group and 587 in the placebo group. Spontaneous birth between 24+0and 33+6weeks occurred in 10.4% of participants in the progesterone group and in 8.2% in the placebo group (odds ratio in the progesterone group, adjusting for the effect of participating center, chorionicity, parity, and method of conception, 1.35; 95% confidence interval, 0.88-2.05; P=.17). In a post hoc time-to-event analysis, miscarriage or spontaneous preterm birth between randomization and 31+6weeks' gestation was reduced in the progesterone group relative to the placebo group (hazard ratio, 0.23; 95% confidence interval, 0.08-0.69).

It was concludedthat in women with twin pregnancies, universal treatment with vaginal progesterone does not reduce the incidence of spontaneous birth between 24+0and 33+6weeks' gestation. However, progesterone may reduce the risk of spontaneous birth before 32 weeks' gestation in women with a cervical length of <30 mm.

Cervical cerclage in singletons

To MS, Alfirevic Z, Heath VC, Cicero S, Cacho AM, Williamson PR, Nicolaides KH; Fetal Medicine Foundation Second Trimester Screening Group. Cervical cerclage for prevention of preterm delivery in women with short cervix: randomised controlled trial. Lancet 2004;363:1849-53.

Cervical cerclage has been widely used in the past 60 years to prevent early preterm birth and its associated neonatal mortality and morbidity. Results of randomised trials have not generally lent support to this practice, but this absence of benefit may be due to suboptimum patient selection, which was essentially based on obstetric history. A more effective way of identifying the high-risk group for early preterm delivery might be by transvaginal sonographic measurement of cervical length. We undertook a multicentre randomised controlled trial to investigate whether, in women with a short cervix identified by routine transvaginal scanning at 22-24 weeks' gestation, the insertion of a Shirodkar suture reduces early preterm delivery.

Cervical length was measured in 47,123 women. The cervix was 15 mm or less in 470, and 253 (54%) of these women participated in the study and were randomised to cervical cerclage (127) or to expectant management (126). Primary outcome was the frequency of delivery before 33 completed weeks (231 days) of pregnancy. The proportion of preterm delivery before 33 weeks was similar in both groups, 22% (28 of 127) in the cerclage group versus 26% (33 of 126) in the control group (relative risk=0.84, 95% CI 0.54-1.31, p=0.44), with no significant differences in perinatal or maternal morbidity or mortality.

(Video) Public Health Strategies to Prevent Preterm Birth

It was concluded that the insertion of a Shirodkar suture in women with a short cervix does not substantially reduce the risk of early preterm delivery. Routine sonographic measurement of cervical length at 22-24 weeks identifies a group at high risk of early preterm birth.

A meta-analysis, which included the above and four other similar trials, was carried out by Berghella V, Ciardulli A, Rust OA, To M, Otsuki K, Althuisius S, Nicolaides K, Roman A, Saccone G (Cerclage for Short Cervix on Ultrasound in Singleton Gestations without Prior Spontaneous Preterm Birth: a Systematic Review and Meta-analysis of Trials using individual patient-level data. Ultrasound Obstet Gynecol 2017;50:569-577). A total of 419 asymptomatic singleton gestations with transvaginal ultrasound cervical length <25 mm and without prior spontaneous preterm birth were analyzed. No statistically significant differences were found in PTB <35, <34, <32, <28, and <24 weeks, mean gestational age at delivery, preterm premature rupture of membranes, and neonatal outcomes, comparing women who were randomized in the cerclage group with those who were randomized in the control group, respectively.

Cervical pessary in singletons

Nicolaides KH, Syngelaki A, Poon LC, Picciarelli G, Tul N, Zamprakou A, Skyfta E, Parra-Cordero M, Palma-Dias R, Rodriguez Calvo J. A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth. N Engl J Med 2016;374:1044-52.

This was a multicenter randomized controlled trial comparing pessary with expectant management, in singleton pregnancies with cervical length ≤25 mm at 20 - 24 weeks’ gestation. Women in both arms of the trial with cervical length <15 mm, at randomization or subsequent visits, were treated with vaginal progesterone. The primary outcome was spontaneous birth at <34 weeks.

A total of 932 women took part in the trial; 465 received cervical pessary and 467 had expectant management. There were no significant differences between thepessaryand the control groups in the rate of spontaneous delivery before 34 weeks (12.0% and 10.8%, respectively; odds ratio in thepessarygroup, 1.12; 95% confidence interval, 0.75 to 1.69; P=0.57), in the rates of perinatal death (3.2% in thepessarygroup and 2.4% in the control group, P=0.42), adverse neonatal outcome (6.7% and 5.7%, respectively; P=0.55), or neonatal special care (11.6% and 12.9%, respectively; P=0.59). The incidence of new or increased vaginal discharge was significantly higher in thepessary group than in the control group.

It was concluded that among women withsingletonpregnancies who had a short cervix, acervicalpessarydoes not result in a lower rate of spontaneous earlypretermdelivery than the rate with expectant management.

(Video) Best ways to prevent preterm birth | Pregnancy tips to prevent preterm birth

Cervical pessary in twins

Nicolaides KH, Syngelaki A, Poon LC, de Paco Matallana C, Plasencia W, Molina FS, Picciarelli G, Tul N, Celik E, Lau TK, Conturso R. Cervical pessary placement for prevention of preterm birth in unselected twin pregnancies: a randomized controlled trial. Am J Obstet Gynecol 2016;214:3.e1-9.

Twins are found in about 2% of pregnancies, but they account for about 25% of preterm births. The objective of this study was to test the hypothesis that the insertion of a cervical pessary in twin pregnancies would reduce the rate of spontaneous early preterm birth. This was a multicenter, randomized controlled trial in unselected twin pregnancies of cervical pessary placement from 20+0-24+6weeks' gestation until elective removal or delivery vs. expectant management. Primary outcome was spontaneous birth <34 weeks.

A total of 1,180 women took part in the trial; 590 received cervical pessary and 590 had expectant management. There were no significant differences between the pessary and control groups in rates of spontaneous birth <34 weeks (13.6% vs. 12.9%; relative risk 1.054, 95% confidence interval [CI] 0.787-1.413; p=0.722), perinatal death (2.5% vs. 2.7%; relative risk 0.908, 95% CI 0.553-1.491; p=0.702), adverse neonatal outcome (10.0 vs. 9.2%; relative risk 1.094, 95% CI 0.851-1.407; p=0.524) or neonatal therapy (17.9% vs. 17.2%; relative risk 1.040, 95% CI 0.871-1.242; p=0.701). A post hoc subgroup analysis of 214 women with short cervix (≤25 mm) showed no benefit from the insertion of a cervical pessary.

It was concluded that in women with twin pregnancy, routine treatment with cervical pessary does not reduce the rate of spontaneous early preterm birth.

Cervical assessment in threatened preterm labor

Alfirevic Z, Allen-Coward H, Molina F, Vinuesa CP, Nicolaides K. Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial. Ultrasound Obstet Gynecol 2007;29:47-50.

False positive diagnosis of preterm labor is common. As a consequence, medications including corticosteroids to promote fetal lung maturity and tocolysis are prescribed unnecessarily. We tested the hypothesis that management of threatened preterm labor (PTL) based on measurement of cervical length (CL) by ultrasonography can reduce the number of women who receive inappropriate treatment.

(Video) Prevention of preterm birth in 2020

Forty-one women with PTL for whom a clinical decision was made to prescribe antenatal corticosteroids and tocolysis were randomized to have their CL measured by transvaginal ultrasound (n=21) or to receive therapy as planned (n=20). Fourteen women in the ultrasound group had a CL >15 mm and the therapy was withheld, while the other seven with CL ≤15 mm were managed in the same way as the control group. Three women (14%) in the ultrasound group were treated inappropriately with antenatal corticosteroids because they remained undelivered for more than a week. This compared favorably with the control group where 18 out of 20 (90%) received corticosteroids unnecessarily (relative risk (RR) 0.16; 95% confidence interval (CI), 0.05-0.39). Tocolysis was given to only seven women (33.3%) in the ultrasound group compared with 20 (100%) in the control group (RR 0.3; 95% CI, 0.15-0.54). There were no babies in either group who were born prematurely without being given a full course of antenatal corticosteroid therapy.

It was concluded that women with TPL and CL >15 mm should not receive tocolysis. The issue of the safety of withholding corticosteroid therapy in this clinical scenario warrants further study.

A meta-analysis of individual participant data, which included the above and two other similar trials, was published by Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G. Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 2017;49:322-329. A total of 287 singleton pregnancies with threatened PTL between 240 and 356 weeks were included, of which 145 were randomized to CL screening with knowledge of results and 142 to no knowledge of CL. Compared with the control group, women who were randomized to the known CL group had a significantly lower rate of PTB < 37 weeks (22.1% vs 34.5%; RR, 0.64, 95% CI 0.44-0.94) and a later gestational age at delivery. It was concluded that in singleton pregnancies with threatened PTL there is a significant association between knowledge of CL and lower incidence of PTB and later gestational age at delivery.


How can a preterm birth best be prevented? ›

See your doctor early and regularly in your pregnancy for prenatal care. Take care of any health problems, like diabetes, high blood pressure, or depression. Don't smoke, drink, or use illegal drugs. Eat a diet that includes a variety of healthy foods.

What is Herron's criteria for preterm labour? ›

Herron and associates(3) (1982) require the following criteria to document preterm labor: Regular uterine contraction after 20 weeks or before 37 weeks of gestation, which are 5 to 8 minutes apart or less, and accompanied by one or more of the following: (1) progressive change in the cervix, (2) cervical dilatation of ...

How successful are progesterone suppositories for short cervix? ›

Vaginal progesterone administered to patients with a transvaginal sonographic short cervix was associated with a significant reduction in the risk of preterm birth ≤ 34 weeks of gestation or fetal death (18.1% vs 27.5%; RR, 0.66 (95% CI, 0.52–0.83); P = 0.0005; I2 = 0%; five studies, 974 women; Table 2 and Figure 3).

Do progesterone shots prevent preterm labor? ›

Vaginal progesterone may help reduce your risk for premature birth if you have a short cervix and are pregnant with just one baby. Progesterone shots may help reduce your risk for premature birth if you're pregnant with just one baby and if you've had a baby that was born early in the past.

What are the 4 factors causing premature birth? ›

Some risk factors for preterm birth include delivering a premature baby in the past, being pregnant with multiples, tobacco use and substance abuse, and short time (less than 18 months) between pregnancies. Additionally, pregnancy complications can result in preterm birth because the baby has to be delivered early.

What is the biggest risk factor for preterm birth? ›

Women younger than age 18 are more likely to have a preterm delivery. Women older than age 35 are also at risk of having preterm infants because they are more likely to have other conditions (such as high blood pressure and diabetes) that can cause complications requiring preterm delivery.

What are the two most important predictors of spontaneous preterm birth? ›

Most preterm births follow spontaneous, unexplained preterm labor, or spontaneous preterm prelabour rupture of the amniotic membranes. The most important predictors of spontaneous preterm delivery are a history of preterm birth and poor socioeconomic background of the mother.

Which patients are at the highest risk of preterm Labour? ›

Risk factors
  • Pregnancy with twins, triplets or other multiples.
  • A span of less than six months between pregnancies. ...
  • Treatments to help you get pregnant, called assisted reproduction, including in vitro fertilization.
  • More than one miscarriage or abortion.
  • A previous premature birth.
Feb 25, 2023

What is the most common indication for preterm birth? ›

Signs and symptoms of preterm labor include:
  • Regular or frequent sensations of abdominal tightening (contractions)
  • Constant low, dull backache.
  • A sensation of pelvic or lower abdominal pressure.
  • Mild abdominal cramps.
  • Vaginal spotting or light bleeding.
Feb 8, 2022

What are the side effects of progesterone suppositories on baby? ›

A Progesterone does not have any harmful effects on babies. For mothers, side effects are rare, but may include redness, soreness, itching or bruising at the site where the shot is given. The suppositories may cause vaginal dryness. Headaches, nausea, vomiting or diarrhea can sometimes occur with either treatment.

What week do you stop progesterone suppositories? ›

While progesterone can be taken up to 37 weeks into pregnancy, it is most commonly prescribed to be taken up to 12 weeks.

Can your cervix lengthen with progesterone? ›

Progesterone has been proven to lengthen pregnancy and reduce the risk of spontaneous preterm birth. If you have a short cervix, progesterone might be something your provider recommends to help your pregnancy continue on as normal a timeline as possible.

What shot helps prevent preterm labor? ›

Makena is a progestin indicated to reduce the risk of preterm birth in women with a singleton pregnancy who have a history of singleton spontaneous preterm birth. The effectiveness of Makena is based on improvement in the proportion of women who delivered <37 weeks of gestation.

Should I take cerclage or progesterone? ›

In a case of singleton pregnancies with no history of preterm birth and shortened cervix, most guidelines recommend progesterone. In singleton pregnancies with a positive history and shortened cervix, all guidelines recommend a cerclage as an option, alternative or conjunct to progesterone.

How can I prevent preterm labor naturally? ›

Ways of Preventing or Reducing the Risk of Premature Birth
  1. Avoid tobacco, smoking, e-cigarettes, and second hand smoke.
  2. Don't drink alcohol while trying to get pregnant and during pregnancy.
  3. Don't use street drugs and avoid misuse of prescription drugs.
  4. Eat a balanced diet with foods containing iron and folic acid.
Oct 5, 2022

What makes a baby come early? ›

Why Are Some Babies Born Early? Babies born before 37 weeks are premature. A premature birth is more likely to happen when a mother has a health problem — like diabetes — or does harmful things during her pregnancy, like smoke or drink. If she lives with a lot of stress, that also can make her baby be born too early.

What is the earliest a baby can be born and survive? ›

By the time you're 24 weeks pregnant, the baby has a chance of survival if they are born. Most babies born before this time cannot live because their lungs and other vital organs are not developed enough. The care that can now be given in baby (neonatal) units means more and more babies born early do survive.

Can stress cause preterm labor? ›

During pregnancy, stress can increase the chances of having a baby who is preterm (born before 37 weeks of pregnancy) or a low-birthweight baby (weighing less than 5 pounds, 8 ounces). Babies born too soon or too small are at increased risk for health problems.

What are the warning signs of premature labor? ›

Warning Signs of Premature Labor

Menstrual-like cramps felt in the lower abdomen that may come and go or be constant. Low dull backache felt below the waistline that may come and go or be constant. Pelvic pressure that feels like your baby is pushing down. This pressure comes and goes.

Which group has the highest rate of premature birth? ›

Preterm Birth
  • In 2021, 1 in 10 babies (10.5% of live births) was born preterm in the United States.
  • The rate of preterm birth in the United States is highest for black infants (14.2%), followed by American Indian/Alaska Natives (11.6%), Hispanics (9.8%), Whites (9.2%) and Asian/Pacific Islanders (8.8%).

What are the main causes of early mortality in preterm infants? ›

The causes of mortality in preterm babies include sepsis, asphyxia, respiratory distress syndrome or hyaline membrane disease, cold injury, intraventricular haemorrhage, necrotising enterocolitis, metabolic and electrolyte disturbances, and congenital disorders such as major congenital heart malformations and ...

Can dehydration cause preterm labor? ›

Dehydration can lead to lower levels of amniotic fluid, which can influence the baby's development, lead to preterm labor, and can affect the production of breast milk. Dehydration can cause deficiencies in nutrients that are vital for the health of the pregnant woman and the developing baby.

What are 3 complications with preterm birth? ›

Necrotizing enterocolitis, or inflammation of the intestines. Neonatal sepsis, or blood infection. Patent ductus arteriosus (PDA), or abnormal blood flow in the heart. Retinopathy of prematurity, or underdeveloped blood vessels in the eye.

What week are most babies born? ›

Twenty-six percent were born in weeks 37 to 38; 57 percent in weeks 39 to 40; 6 percent in week 41; and less than 1 percent at 42 weeks or beyond.

Can progesterone cause birth defects? ›

Does taking progesterone or progestin increase the chance of birth defects? Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. It is unlikely that using progesterone or a progestin will increase the chance of birth defects.

Can progesterone pills harm baby? ›

Progesterone treatment is safe to use in pregnancy.

Will progesterone save my baby? ›

Background: Progesterone is essential for a healthy pregnancy. Several small trials have suggested that progesterone therapy may rescue a pregnancy in women with early pregnancy bleeding, which is a symptom that is strongly associated with miscarriage.

When does placenta take over progesterone? ›

About six weeks into pregnancy, the placenta takes over making progesterone, a critical handoff. (The placenta also makes other hormones, including human chorionic gonadotropin, which is detected in a pregnancy test.)

Will I miscarry if I stop taking progesterone? ›

In natural pregnancies, at around seven weeks the placenta will make all the progesterone needed for a woman to stay pregnant. Even if you removed the ovaries and stopped all progesterone, the women won't have an increased risk of miscarriage!

Does progesterone affect gender? ›

Maternal progesterone administration increased male, but not female, fetal progesterone concentrations, also increasing circulating 11-dehydrocorticosterone in male fetuses. Maternal progesterone administration altered fetal pituitary and testicular function in ovine male fetuses.

Can you have a full term pregnancy with a short cervix? ›

If you have a short cervix, you have a 1-in-2 chance (50 percent) of having a premature birth, before 37 weeks of pregnancy. So if you have a short cervix and you're pregnant with just one baby, your health care provider may recommend these treatments to help you stay pregnant longer: Cerclage. Vaginal progesterone.

Does bed rest help a short cervix? ›

Activity restriction, including bed rest, is often recommended for women who are at risk for premature birth. However, bed rest has not proved to help stave off labor for women with a short cervix, so it is usually unnecessary for those with this condition.

Can cervical length increase with bed rest? ›

Based on these results, we conclude that therapeutic cerclage with bed rest increases cervical length and that bed rest alone has a variable but, on average, negligible effect on cervical length.

Does Makena shot work? ›

In a clinical study, taking Makena significantly lowered the rate of preterm birth compared to moms who did not take Makena. If you answer “yes” to all of the questions below, talk with your healthcare provider to see if Makena could help you reduce your risk of another preterm birth.

Can oxytocin prevent preterm labor? ›

Conclusion: It is confirmed biochemically and pharmacologically that oxytocin plays an important role in the initiation of both term and preterm labor in rats. The oxytocin antagonist examined was able to delay term and preterm labor, so it might prove useful in clinical practice for the treatment of preterm labor.

What shot should parents get before baby is born? ›

Whooping cough vaccine for those around babies

The best way to protect newborns from whooping cough is to make sure pregnant women get a whooping cough shot (called Tdap vaccine) during each pregnancy.

Can you go full term with cerclage? ›

Success of the cervical cerclage procedure is defined as a pregnancy that lasts until term or close to term. Cerclage can help some high-risk pregnancies last longer.

How successful is a preventative cerclage? ›

Cervical cerclage helps prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in 85% to 90% of cases.

When is the best time to get a cerclage? ›

A cervical cerclage is a treatment that involves temporarily sewing the cervix closed with stitches. This may help the cervix hold a pregnancy in the uterus. A cerclage is done in the second trimester of pregnancy to prevent preterm birth.

Can bed rest prevent preterm labor? ›

There is no evidence that bed rest during pregnancy — at home or in the hospital — is effective at treating preterm labor or preventing premature birth.

What foods prevent preterm labor? ›

Pregnant women who eat a 'prudent' diet rich in vegetables, fruits, whole grains and who drink water have a significantly reduced risk of preterm delivery, suggests a study. A "traditional" dietary pattern of boiled potatoes, fish and cooked vegetables was also linked to a significantly lower risk.

What is Heron criteria? ›

Here is Heron's Criterion: the wedges of the strip can be assembled into a triangle as shown, if and only if the extended line LA goes through the circumcentre of the triangle ABM. The argument takes place almost entirely inside the circumcircle of AMB.

How do they determine preterm labor? ›

If you're experiencing regular uterine contractions and your cervix has begun to soften, thin and open (dilate) before 37 weeks of pregnancy, you'll likely be diagnosed with preterm labor.

What would be considered preterm labor? ›

A term pregnancy takes about 40 weeks to complete. Babies born before 37 weeks may have problems breathing, eating and keeping warm. Premature labor occurs between the 20th and 37th week of pregnancy, when uterine contractions cause the cervix, the mouth of the uterus or womb, to open earlier than normal.

What is positive fFN in pregnancy? ›

Results of the fetal fibronectin test are either positive or negative: Positive. A positive result means that fetal fibronectin is present in your cervical secretions. If you have a positive result between weeks 22 and 34, you're at increased risk of premature birth within seven days.

What are herons known for? ›

Great blue herons are waders, typically seen along coastlines, in marshes, or near the shores of ponds or streams. They are expert fishers. Herons snare their aquatic prey by walking slowly, or standing still for long periods of time and waiting for fish to come within range of their long necks and blade-like bills.

Are heron protected? ›

Grey herons are protected under the Wildlife and Countryside Act (1981, as amended) making it illegal to kill, catch, hold herons in captivity and to wilfully destroy nests. ❖ Water quality Improvements in water quality leads to higher natural fish populations.

Who invented heron's formula? ›

Heron's formula, formula credited to Heron of Alexandria (c. 62 ce) for finding the area of a triangle in terms of the lengths of its sides.

Does bed rest prevent preterm labor? ›

Is bed rest recommended? There is no evidence that bed rest during pregnancy — at home or in the hospital — is effective at treating preterm labor or preventing premature birth.

Can preterm labor be stopped? ›

In some cases, yes. For about 3 in 10 women, preterm labor stops on its own. If it does not stop, treatments may be given to try to delay birth. In some cases, these treatments may reduce the risk of complications if the baby is born.

How accurate is the preterm labor test? ›

A positive test isn't highly accurate at predicting preterm labor. In fact, many people with positive results achieve a full-term pregnancy. A positive result suggests your provider should monitor you closely. However, a negative result is very accurate in predicting that labor won't occur in the next 14 days.

Can you see preterm labor on ultrasound? ›

The cervix is the opening or passage through which the baby must pass before being born vaginally. Ultrasound can detect early changes of the cervix, such as shortening of the cervical length, to predict preterm birth.

What cervical length is preterm labor? ›

A cervix that is less than 25 mm may be indicative of preterm birth.


1. March of Dimes Database for Preterm Birth Research
2. Clinical management of preterm birth: from the prevention to the treatment - G. Donders
3. Dr. David Aronoff - Preventing Preterm Birth initiative
4. Progesterone and Prevention of Preterm birth in IVF Pregnancies
(Women Pedia Pro)
5. Session 3 - 01 Community Clinic Board Meeting re Preterm Birth Prevention
(Association of Professors of Gynecology and Obstetrics (APGO))
6. Our quest to prevent preterm birth: together we can make a difference
(Women and Infants Research Foundation)
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