Preterm birth: a puzzle worth solving.

The incidence of preterm birth has not declined in spite of obstetric and neonatal advances. Although results are variable, the majority of preterm birth prevention programs that embody risk assessment, patient education, and frequent provider visits have shown promise in reducing early births compared with those patients receiving standard care. More recently, home uterine activity monitoring has been shown to be accurate in demonstrating contraction frequency. The combination of this assessment method to detect increased uterine activity at the earliest possible time and intensive perinatal nursing support as to symptomatology related to preterm labor has led to an earlier detection of preterm labor. This, when combined with a comprehensive program of preterm birth prevention, has in many studies resulted in a decrease in the number of early deliveries. To achieve reduction in preterm births, however, these programs must be integrated with aggressive physician management of tocolytic therapy of such patients and continued intensive involvement in such gestations.