Diagnosis and treatment of threatened preterm birth

Preterm birth, defined as delivery before 37 weeks of gestation, is a leading cause of neonatal mortality and long-term health complications, including neurological and behavioral disorders. Despite its significant impact, the causes of preterm birth are still not fully understood and are believed to involve a complex interplay of genetic, environmental, and lifestyle factors. This dissertation investigates strategies to better predict and manage preterm birth.
The first part investigates predictive factors for preterm birth, with a focus on ethnic disparities and urban living conditions. Additionally, it critically evaluates the implementation of the fibronectin test, a diagnostic tool for ruling out imminent preterm birth. Given the potential of the fibronectin test to significantly reduce unnecessary interventions, optimize resource allocation, and alleviate parental stress, what systemic barriers in healthcare financing and policy are impeding its widespread adoption, and how might overcoming these obstacles transform the management of threatened preterm birth?
The second part presents a comprehensive analysis of tocolytic use in managing threatened preterm birth. It starts with an extensive historical review of tocolytic research, followed by an Individual Participant Data Meta-Analysis comparing nifedipine and atosiban, the two most commonly used tocolytics. The study then extends to a long-term follow-up investigation, assessing neurodevelopmental outcomes in children exposed to these tocolytics in utero. This research addresses the ethical challenges of conducting placebo-controlled trials in this field by using a propensity score analysis to compare tocolysis with no treatment, and to shed light on the true clinical benefit of tocolytic therapy in these cases.