Pregnancy-Related Complications and Preterm Delivery

Abstract

Whilst most aspects of obstetrics impact on neonatal care, in this chapter, we have focussed on the areas that we consider have the greatest effect: prematurity and stillbirth prevention. The current knowledge regarding prematurity prevention relies on identification of women at highest risk of preterm birth. New risk factors are now being identified, the most recent being previous cervical surgery and previous second stage Caesarean section. Interventions to prevent preterm birth are largely limited to the antenatal period and include cervical cerclage. However newer interventions are now being trialled including progesterone treatment and the use of the Arabin pessary. Once preterm labour occurs, the focus is on optimising the condition of the preterm neonate by use of antenatal corticosteroids, antibiotics and magnesium sulfate, with careful consideration of mode of delivery. Whilst stillbirth prevention may not seem as relevant to neonatal care, it is a major international focus within obstetrics. The consequence of this is an inevitable increase in intervention in late pregnancy to deliver babies identified as at increased risk of adverse outcome, thereby increasing the incidence of iatrogenic prematurity.