Preterm labour and birth: prevention strategies and preparation for delivery

Preterm birth (PTB) is the leading cause of child mortality (under the age of 5 years), and accounts for 10% of all births worldwide. It is the most important single determinant for infant survival and quality of life. The aetiology of PTB is multifactorial; spontaneous PTB is often associated with cervical weakness, infectious processes, uterine overdistension or a decline in progesterone function. Iatrogenic PTB is predominantly due to maternal medical conditions such as pre-eclampsia or fetal growth restriction. This article will review the key elements of risk assessment and stratification, additional screening protocols following secondary care referral, and prophylactic management strategies for the prevention of PTB. It will also provide an overview of perinatal optimization when PTB is planned or imminent. It encompasses guidance from NICE, RCOG, UK Preterm Birth Network and BAPM to consolidate information in a concise and comprehensive format.