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Problems and challenges in the management of preterm labour
Author(s) -
McNamara Helen M.
Publication year - 2003
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1046/j.1471-0528.2003.00042.x
Subject(s) - etiology , medicine , preterm labour , intensive care medicine , fetal fibronectin , psychological intervention , disease , modalities , pregnancy , preterm delivery , fetus , nursing , pathology , social science , gestation , sociology , biology , genetics
The main problem with preterm labour is our lack of progress in the successful management of this condition. We need to reassess our approach to this problem because preterm labour is not a disease, but an event, which may result from multiple independent pathways. This problem has also been affected significantly by medical advances such as infertility treatments and changes in neonatal survival at the limit of viability. The specific challenges that we face in managing preterm labour include: problems with definition; aetiology, including genetic and infection components; diagnostic problems, such as true versus false labour and role of cervical length and fetal fibronectin; and specific interventions according to the antepartum, intrapartum and postpartum challenges. In order to address the main issue, and make future progress in the management of preterm labour, we should consider the implementation of a ‘Postpartum Preterm Labour Diagnostic Workup Protocol’. These data/workup results could be entered on web‐based databases for each preterm labour ‘event’. An international research team could analyse data relating to specific aetiological patterns and subgroup analyses, leading to the collaborative development of ‘aetiology specific’ management modalities. This approach requires a close collaboration between clinicians and researchers, in order to make significant progress in this difficult area, and ultimately improve perinatal outcomes.