Enf.ª Patrícia Sancho

Specialist in Maternal 
and Obstetric Health
Head of Nursing Services Gynaecology/Obstetrics Unit
Doctorate in Educational Sciences

Prenatal care in the golden standard of premature birth prevention

HPA Magazine 22 // 2024

Preterm birth is a public health problem (Amegah, 2023) that affects millions of babies and families around the world. It is estimated that for every 10 babies born, 1 is premature, and every 40 seconds, 1 of these babies does not survive (WHO, 2023 a)).
More than 80% of all newborn deaths result from three preventable and treatable conditions, one of which is complications due to prematurity (WHO, 2014).
A premature birth (below 37 weeks) is one of the most demanding and complex challenges in Obstetrics, as it deprives the foetus of the development that occurs in the last weeks of pregnancy, potentially leading to incomplete formation and development of organs such as the brain, lungs, and liver.

The earlier a baby is born prematurely, the higher the rates of death or disability, including respiratory issues, developmental delays, vision problems, hearing problems, among others (CDCP, 2024; ACOG, 2021).

An abrupt outcome of pregnancy before full term also has an emotional impact on the woman and family, in addition to greater economic costs (CDCP, 2024). Considering
that premature birth is a leading cause of neonatal mortality and the most common reason for prenatal hospitalization (ACOG, 2016), investing in the prevention of premature birth is crucial.

The European Foundation for the Care of Newborn Infants (EFCNI, 2022) emphasizes that prevention should start in the pre-conception phase.
Good health surveillance, recognizing risk signs, and adopting healthier lifestyle habits can reduce the risk of premature birth during pregnancy (EFCNI, 2022; WHO, b)).

During pregnancy, vigilance is essential, including early screenings around 12 weeks of gestational age, maintaining a healthy diet, avoiding smoking and drug use, engaging in appropriate physical activity, getting enough rest, and maintaining emotional well-being, all of which are protective factors in preventing premature birth (EFCNI, 2022; WHO, 2023 c); APBP, s/d).

In pregnancy, during prenatal care, in addition to screening, particularly the 1st trimester screening for the risk of pre-eclampsia, there are other preventive measures, such as measuring the cervix during the 2nd trimester ultrasound, as well as taking medication, which can be indicated if the cervix is shortened or if there is a history of premature labour. The use of the foetal fibronectin test, whether or not combined with measuring the cervix in symptomatic pregnant women, can help, but should not be used exclusively to direct treatment in the context of acute symptoms (ACOG, 2021). Consideration may also be given to cerclage (suturing the cervix closed) (APBP, n.d.), among other pharmacological measures that can prolong pregnancy, control possible infection and/or inhibit uterine contractions (ACOG, 2021). 

The non-pharmacological measures adopted, such as total rest, abstinence from sexual intercourse and hydration, lack evidence regarding their effectiveness in preventing preterm labour, and even have adverse effects that have been described. However, their adoption when there is a threat of preterm labour should be considered as a complement to treatment, depending on the clinical context and gestational age (ACOG; 2021).

This year, the International Federation of Gynecology and Obstetrics is launching the PremPrep-5 initiative, which aims to disseminate information on 5 simple and effective interventions in the approach to premature birth. These are: taking corticosteroids and magnesium sulphate during pregnancy; during labour, late clamping of the umbilical cord (for at least 1 minute, unless the baby needs resuscitation manoeuvres) and after birth, early supply of human milk and the immediate kangaroo method (Megan, 2024; ACOG, 2021).

Currently, 2.6 million babies worldwide do not survive, and most of these deaths are preventable (Lawn, 2024), underscoring the importance of preventive measures and early detection of premature birth in Obstetrics.