Preventing and reducing the morbidity and mortality of preterm birth in singleton pregnancies

Key content Preterm birth (PTB), defined as delivery before 37 weeks of gestation, affects approximately 13.4 million infants annually worldwide (9.9% of all births). PTB is a complex obstetrical syndrome with a diverse range of aetiologies, complicating screening and prevention strategies. Primary prevention of PTB should include access to appropriate antenatal care, dating ultrasound, screening for and treatment of infection, adequate nutritional status, and avoidance of iatrogenic PTB where modifiable risks are present. Secondary preventative approaches include progesterone, cervical cerclage, and the use of cervical pessaries. In cases of unavoidable PTB, the optimisation of perinatal outcomes can be achieved with timed antenatal maternal corticosteroid administration, magnesium sulphate, and access to specialised neonatal care. Learning objectives To review the burden of both spontaneous and iatrogenic preterm births globally. To understand primary, secondary, and tertiary interventions to reduce the incidence of preterm birth in both high‐and low‐resource settings. To understand how perinatal outcomes can be optimised in cases where PTBs are unavoidable. Ethical issues Resource allocation and equity in low‐ and middle‐income countries. Counselling patients on the complexities of both preventing and preparing for, a spontaneous preterm birth. Optimising care for extremely preterm infants to reduce morbidity and mortality.