Clinical Updates on Management & Outcomes of Extreme Preterm Birth

The panel advised for shared decision making and counselling to women and their families to be partners in clinical decision making. They noted that the active participation of parents in treatment may positively influence bonding as well as longer-term outcomes for child and family.

They further recommended the following best practice for obstetrics management:

• “Transfer the mother antenatally to a tertiary centre that can provide appropriate care to optimise the outcome
• Tocolysis may be useful if it is safe for mother and baby to delay delivery short term and allow timely administration of antenatal corticosteroid treatment
• Administer antenatal corticosteroids to facilitate fetal lung maturation
• Provide peripartum magnesium sulphate infusion to reduce neurological injury (as recommended by the National Institute for Health and Care Excellence (NICE) in the UK and various professional societies)
• Caesarean section is indicated for risks to the mother’s life or when an agreement has been made to resuscitate the neonate and labour would be detrimental to the outcome
• Perform delayed cord clamping of at least 60 seconds to facilitate placental transfusion to the newborn”.

For prevention of preterm birth, the panel recommended the following:

• “Both partners should stop smoking; even smoking cessation during pregnancy protects against preterm birth. Behavioural interventions for smoking cessation during pregnancy are effective, but evidence for the efficacy of drugs or nicotine replacement therapy is limited
• Optimise care of existing maternal medical diseases such as hypertension, diabetes and thyroid disorders
• Advice on healthy diet and exercise as being underweight or overweight increases the risk of complications including congenital anomalies, pre-eclampsia and small for gestational age, all of which may contribute to extreme preterm delivery
• Advise women before conceiving to reduce alcohol and caffeine consumption, stop recreational drugs, take folic acid, and ensure adequate vitamin D intake
• Screen for sexually transmitted infections in higher-risk women as these are associated with preterm birth
• Consider mid-stream urine culture (MSU) in early pregnancy as asymptomatic urinary tract infection and pyelonephritis is associated with preterm birth
• Low dose aspirin begun before 16 weeks of gestation reduces the risk of pre-eclampsia, fetal growth restriction and associated preterm birth
• Other interventions to reduce preterm birth include vaginal progestogen and cervical cerclage”.

For further information:

DOI: https://doi.org/10.1136/bmj-2021-055924