Preventing the complications of preterm birth.

Preterm birth is a major cause of infant morbidity and mortality. Although studies have been complicated by problems of definition and methodology, certain strategies have the potential to reduce both the incidence and the impact of preterm birth. These strategies include accurate assessment of gestational age, education about the signs and symptoms of early labor, recommendations for smoking cessation, and screening for asymptomatic bacteriuria in all prenatal patients. In addition, specific interventions such as cervical cerclage may be indicated in certain patients. The role of home uterine monitoring is not yet established. If preterm labor does occur, tocolysis should be used to delay delivery, and in appropriate cases the patient should be transferred to a medical center with a neonatal intensive care unit. Antenatal administration of corticosteroids in preterm labor appears to significantly reduce fetal morbidity.