Prenatal Risk Assessment for Preterm Birth in Low-Resource Settings: Demographics and Obstetric History

Abstract

AbstractMaternal demographics and past obstetric history provide important information regarding the risk of preterm birth. Careful assessment for these factors at pregnancy registration is crucial for preterm birth risk assessment and signposting of care to mitigate preterm birth where possible. Demographic factors evidenced to increase the risk of PTB include extremes of maternal age, black ethnicity, and history of domestic abuse. Obstetric risk factors include a history of previous preterm birth, late miscarriage, stillbirth, cervical surgery, or uterine variants. In an index pregnancy, multiple pregnancy is a main predictor of preterm birth. Early pregnancy risk assessment for these factors can inform generic measures aimed at mitigating the occurrence and consequences of preterm birth. Importantly, further risk assessment and surveillance, including where possible assessment of the cervix for shortening by transvaginal ultrasound, can inform antenatal care to optimise birth outcomes, by referral to a preterm birth prevention or high risk pregnancy service, or offering cervical cerclage or progesterone supplementation.