Prediction of preterm delivery

Preterm delivery is in quantity and in severity an important issue in the obstetric care in the Western world. There is considerable knowledge on maternal and obstetric risk factors of preterm delivery. Of the women presenting with preterm labor, the majority is pregnant with a male fetus and in Caucasian women the risk of preterm delivery is enlarged if they are pregnant with a male fetus.
Accurate prediction of those women with symptoms of preterm labor who will deliver prematurely is difficult. Digital examination, measurement of the cervical length by transvaginal ultrasound and testing for the presence or absence of fetal fibronectin improve the risk assessment of spontaneous preterm delivery within the following seven days. Also in the Dutch obstetric care system the fetal fibronectin test is applicable. The digital examination of the cervix, often performed before fibronectin testing, appears to be of little influence on the reliability of the fibronectin test. Accurate prediction of preterm delivery is of great importance in the timing of the treatment with antenatal corticosteroids. Administration of antenatal corticosteroids to the mother enhances fetal lung maturity and reduces fetal mortality. The treatment effect, however, diminishes if the interval between the administration and delivery becomes longer than seven days. Timing of corticosteroids appears to be difficult in pregnant women presenting with vaginal blood loss or preterm labor. In women with preterm labor the administration of antenatal corticosteroids can be improved by implementation of the cervical length measurement and fibronectin result in the treatment strategy.