Trio of strategies may help prevent preterm birth: high-risk women.(Obstetrics)

LISBON -- There are three main questions you should ask yourself when faced with a woman at risk of preterm labor and delivery, experts agreed at a world congress sponsored by the Fetal Medicine Foundation.

The questions are:

1. Should I perform a cerclage? Data are increasingly suggesting that cerclage is of some benefit in women at high risk for preterm delivery, Dr. Zarko Alfirevic said.

A review of several studies revealed that about 1 in 8 high-risk women without cerclage will deliver before 32 weeks' gestation, compared with about 1 in 10 high risk women who do undergo cerclage, said Dr. Alfirevic of the University of Liverpool (England).

Pooled data from other studies, including one involving more than 22,000 women with cervical length less than 15 mm, showed a benefit with cerclage that did not quite reach statistical significance. Additional study is needed to determine more precisely when the procedure should be performed, to identify which risk factors indicate a need for cerclage, and to determine if there is a statistically significant benefit of cerclage in certain women.

For now, it does appear that there may be clinical benefit, and cerclage is worth considering in those at high risk for preterm labor and 'delivery. "But don't promise miracles," he added.

2. Should I test for and treat bacterial vaginitis? There is no doubt that BV is related to the risk of preterm delivery, Dr. Steve Thornton said.