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Preterm labour
Current Obstetrics & Gynaecology (1996) 6, 125 © 1996 Pearson Professional Lid
Editorial
Preterm labour
M. J. Whittle
The subject of preterm labour was last covered in Current Obstetrics and Gynaecology in December 1992. Has much changed? All the authors indicate in different ways that in fact very little progress has been made in the last 4 years. Prematurity remains the commonest cause of neonatal death in the normally formed baby and the incidence of preterm birth remains fairly constant at about 6% to 7% in the UK. Much attention has, quite rightly, been focused on infection as a predominant cause but as Professor Taylor points out the intervention studies which use antibiotics offer generally unclear conclusions. The result of the ORACLE study are eagerly awaited. Epidemiology itself does not offer clear guidance although it is possible to identify at-risk groups. Thus, those with a history of a previous preterm birth, who have a multiple pregnancy, and those disadvantaged members of our society, are particularly prone to preterm birth. However, in spite of being able to identify them, little evidence suggests a significantly effective intervention.
The role of the investigation of those women who have delivered early may be particularly important but, as with other issues concerning preterm labour, little data exist. However, one of the particularly important points made by Drs Somerset and Kilby is the need for thorough review of those cases in which preterm birth has occurred even if the baby has survived. So often these are the very cases which are not seen again until another pregnancy is established. Maybe the woman should have had an opportunity to have realised the risks she and her baby may face? What might alter in the next 4 years? Certainly our ideas about underlying mechanisms are becoming more sophisticated and it may be that molecular biological techniques may provide us with a better insight from which may lead specific pharmacological strategies. The possibility that we may get a better idea about uterine activity and how to monitor it antenatally may also contribute. Prematurity remains one of our greatest problems and any signifcant breakthrough would lead to greatly improved perinatal and long-term outcomes. It is a challenge worth facing.
M. & Whittle, Department of Fetal Medicine, Birmingham Maternity Hospital, Edgebaston, Birmingham B15 2TG, UK
125
Editorial
Preterm labour
M. J. Whittle
The subject of preterm labour was last covered in Current Obstetrics and Gynaecology in December 1992. Has much changed? All the authors indicate in different ways that in fact very little progress has been made in the last 4 years. Prematurity remains the commonest cause of neonatal death in the normally formed baby and the incidence of preterm birth remains fairly constant at about 6% to 7% in the UK. Much attention has, quite rightly, been focused on infection as a predominant cause but as Professor Taylor points out the intervention studies which use antibiotics offer generally unclear conclusions. The result of the ORACLE study are eagerly awaited. Epidemiology itself does not offer clear guidance although it is possible to identify at-risk groups. Thus, those with a history of a previous preterm birth, who have a multiple pregnancy, and those disadvantaged members of our society, are particularly prone to preterm birth. However, in spite of being able to identify them, little evidence suggests a significantly effective intervention.
The role of the investigation of those women who have delivered early may be particularly important but, as with other issues concerning preterm labour, little data exist. However, one of the particularly important points made by Drs Somerset and Kilby is the need for thorough review of those cases in which preterm birth has occurred even if the baby has survived. So often these are the very cases which are not seen again until another pregnancy is established. Maybe the woman should have had an opportunity to have realised the risks she and her baby may face? What might alter in the next 4 years? Certainly our ideas about underlying mechanisms are becoming more sophisticated and it may be that molecular biological techniques may provide us with a better insight from which may lead specific pharmacological strategies. The possibility that we may get a better idea about uterine activity and how to monitor it antenatally may also contribute. Prematurity remains one of our greatest problems and any signifcant breakthrough would lead to greatly improved perinatal and long-term outcomes. It is a challenge worth facing.
M. & Whittle, Department of Fetal Medicine, Birmingham Maternity Hospital, Edgebaston, Birmingham B15 2TG, UK
125