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Abstract

Prediction and prevention of preterm birth

Preterm birth is the most important cause of perinatal morbidity and mortality. In 2010 preterm births accounted for 77 % of neonatal deaths in Germany. With 9 % infants being born preterm Germany has one of the highest preterm birth rates in Europe. Since the pathophysiology underlying preterm birth is a multifactorial event, causal therapy is difficult. Therefore early prediction and prevention are of crucial importance. However an efficient screening does not exist. Generally, cessation of smoking, antibiotic therapy of asymptomatic bacteriuria and treatment of bacterial vaginosis before 20 weeks of gestation lead to a significant reduction of the risk of preterm birth. Moreover, supplementation of progesterone prevents preterm birth. The biochemical markes fibronectin or phIGFBP (phosphorylated insulin-like growth factor binding protein- 1) can support the decision for or against interventions such as tocolysis or antenatal corticosteroids. Last but not least the primary aim of tocolytic treatment is the completion of one cycle of antenatal corticosteroids and the »in utero« transport to a perinatal center to ensure optimal treatment of the preterm infant.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2013; 9(3): 238–249

Keywords
Preterm birth, neuroprotection, progesterone, fibronectin, IGFBP

Michael König, Holger Maul
Frauenklinik, Kath. Marienkrankenhaus gGmbH, Hamburg
Reviewer: Heribert Kentenich, Berlin,
und Burkhard Schauf, Bamberg

Maul H. Prädiktion ... Gynakol Geburtsmed Gynakol Endokrinol 2013; 9(3): 238–249 publiziert 30.11.2013 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2013 ISSN 1614-8533