Why Aren’t We Talking About Preterm Birth?

Why Aren’t We Talking About Preterm Birth?

By: M. Sean Esplin, MD

Associate Professor of Obstetrics & Gynecology
University of Utah Health Sciences Center
Division of Maternal Fetal Medicine

If I told you that you were at risk for a heart attack, would you want that information? Of course you would. And you would say, ‘what can I do to reduce my risk?’ The same doesn’t apply to preterm birth. We don’t talk about it. It’s still our biggest problem in obstetrics, the leading cause of neonatal morbidity and mortality in the United States, and a serious financial and emotional issue.

When I hear my colleagues opine about this, I see their frustration with the topic. Their mindset is that if we talk to women about preterm birth, we’re just scaring them. So we wait for symptoms. At that point, it’s too late to make a big difference. So clinicians end up frustrated, with a sense of hopelessness. 

If you told a cardiologist, ‘don’t worry about your patient until they have symptoms, and then we’ll treat him’, that would seem crazy. Once again, that is what we are doing with preterm birth. The earlier we have an idea that someone is at risk, the better chance we have of stopping the process that’s beginning. 

We’re becoming more and more aware that parturition—the process that leads up to delivery—is actually happening 4, 6, or even 8 weeks prior to signs or symptoms. There is really an advantage of knowing when things are starting early and intervening early.

Right now, the interventions that work to prevent preterm birth start early, and they are used in women who have risk factors for preterm birth—women who have had a prior spontaneous preterm birth, women with a short cervix. When we take those women and treat them—e.g., increased surveillance, increased social support, progesterone, or taking care of them in a different way, like CenteringPregnancy®—we’ve shown that you can prolong their pregnancy. 

That’s an important point. All we need to do is prolong their pregnancy by one or two weeks, and we’ll have a huge impact on morbidity, mortality and cost. These interventions that are relatively easy and inexpensive—seeing patients more often, screening for infection, talking about symptoms, making sure patients know they can’t ignore symptoms, monitoring their cervical length with serial ultrasound—they can make a difference and prolong pregnancy by one or two weeks.

It’s these personalized interventions that we haven’t been able to do, because we don’t know who is going to have a preterm birth. So, we need an easy and accurate method to predict preterm birth risk early, before the symptoms start. If you tell me to focus on these 20 patients, I can give them enhanced care, involve them in that care, and ask them to be watching for symptoms. It also gives me a little more power when I say, ‘I want you to do this or that’, and they will take it more seriously.

Soon, with a powerful predictor of preterm birth, we will be able to predict early and start interventions early. We also need to give ALL women essential education about preterm birth and symptoms of preterm labor. There’s hope that we can make a big difference.