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Obstetrics and Gynecology Clinics0889-8545391March 2012 © 2012 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.obgyn.theclinics.com/article/PIIS0889854512000022/abstract?rss=yesCME Accreditation Page and Author Disclosure10.1016/j.ogc.2012.01.001Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-2iiiiiihttp://www.obgyn.theclinics.com/article/PIIS0889854512000095/abstract?rss=yesContributors10.1016/S0889-8545(12)00009-5Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-2vvihttp://www.obgyn.theclinics.com/article/PIIS0889854512000101/abstract?rss=yesContents10.1016/S0889-8545(12)00010-1Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-2viiixhttp://www.obgyn.theclinics.com/article/PIIS0889854512000113/abstract?rss=yesForthcoming/Recent Issues10.1016/S0889-8545(12)00011-3Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-2xxhttp://www.obgyn.theclinics.com/article/PIIS0889854512000046/abstract?rss=yesWe have not focused on an issue in the Obstetrics and Gynecology Clinics of North America about preventing or delaying preterm delivery in several years. Many advances have received attention in the past decade, so we wish to provide an important update on “Management of Preterm Birth.” While numerous management methods have incorporated such diagnostic evaluations as cervical length measurements and the presence or absence of fetal fibronectin, the incidence of preterm birth has changed little over the past 40 years. Uncertainty continues about the best strategies for managing preterm labor.Management of Preterm Birth: Best Practices in Prediction, Prevention, and TreatmentWilliam F. Rayburn10.1016/j.ogc.2012.02.002Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-2xixiihttp://www.obgyn.theclinics.com/article/PIIS0889854512000034/abstract?rss=yes Preterm birth, or delivery prior to 37 weeks' gestation, continues to be a major public health concern in the United States and is the leading cause of infant mortality excluding congenital malformations. The annual health care costs for the care of infants born preterm are substantial. However, for the first time in decades, the preterm birth rate in the United States has reached a plateau and begun to decline slightly, currently accounting for just over 12% of the 4 million births annually in the country. Fortunately, with increased public awareness to this plight of women and infants as well as funding for research and attention to outcomes by the federal government and private agencies, the busy clinician now has more effective options than ever before for screening, prevention, and treatment of women at risk for preterm birth.PrefaceAlice Reeves Goepfert10.1016/j.ogc.2012.02.001Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-2xiiixvhttp://www.obgyn.theclinics.com/article/PIIS0889854511001276/abstract?rss=yesPreterm birth, defined as delivery before 37 weeks of gestation, is the second leading cause of infant mortality in the United States after congenital malformations. Spontaneous preterm birth, due to either preterm labor or preterm premature rupture of membranes (PPROM), encompasses approximately 75% of all cases of preterm birth, almost 400,000 births per year. Since the 1960s, different formulations of progesterone have been investigated for their role in preterm birth prevention. This article discusses the use of progesterone for the prevention of preterm birth, including selection of candidates for progesterone, pharmacokinetics, dosing, and formulations. The goal of this article is to provide a practical guide for using progesterone in clinical practice.Progesterone for Preterm Birth PreventionCarla E. Ransom, Amy P. Murtha10.1016/j.ogc.2011.12.004Obstetrics and Gynecology Clinics 39, 1 (2012)2012-01-27Obstetrics and Gynecology Clinics2012-01-27391S0889-8545(11)X0006-2116http://www.obgyn.theclinics.com/article/PIIS0889854511001318/abstract?rss=yesPreterm birth, defined as delivery at fewer than 37 weeks' gestation, is the most common cause of infant morbidity and mortality among nonanomalous infants in the United States. Preterm birth is responsible for 75% of neonatal mortality and 50% of long-term disability in children. Approximately 20% of infant deaths are due to preterm birth, and survivors experience significant and life-long morbidity. Despite advances in basic, clinical, and translational research, as well as medical interventions to reduce preterm birth, the preterm birth rate has remained unchanged over the years.Periodontal Disease and Preterm BirthAmanda L. Horton, Kim A. Boggess10.1016/j.ogc.2011.12.008Obstetrics and Gynecology Clinics 39, 1 (2012)2012-02-02Obstetrics and Gynecology Clinics2012-02-02391S0889-8545(11)X0006-21723http://www.obgyn.theclinics.com/article/PIIS0889854511001240/abstract?rss=yesPreterm birth continues to among the most problematic obstetrical issues, with an annually increasing incidence, now approaching 13% in the United States. Most are not indicated for maternal/fetal complications, and so comprise the spontaneous preterm birth syndrome. This syndrome includes multiple inciting factors, interrelated pathways, and several anatomic and related functional components; the underlying pathophysiology remains elusive and difficult to study. One anatomic component of this syndrome is the cervix, and when pathologic cervical changes predate uterine contractions or chorioamnion rupture, this has been clinically recognized as cervical insufficiency.Cervical Cerclage for the Prevention of Preterm BirthJohn Owen, Melissa Mancuso10.1016/j.ogc.2011.12.001Obstetrics and Gynecology Clinics 39, 1 (2012)2012-01-06Obstetrics and Gynecology Clinics2012-01-06391S0889-8545(11)X0006-22533http://www.obgyn.theclinics.com/article/PIIS0889854511001288/abstract?rss=yesIn 2005 the phrase “late preterm” was introduced by the National Institute of Child Health and Human Development (NICHD) to characterize infants born between 34 0/7 and 36 6/7 weeks of gestation as a high-risk group with increased morbidities when compared with term infants. This replaced the earlier phrase “near term,” which implied these infants behaved similarly to term infants. Limiting this group to neonates born from 34 to 36 weeks also helped focus research on this cohort, allowing investigators to better characterize their outcomes. We now have ample data that show most morbidities related to prematurity are increased in the late preterm group when compared with infants born at term, most markedly where respiratory morbidities are concerned. This heightened awareness of adverse outcomes raises the question of whether delivery in this period for a variety of indications can be avoided. The focus of this article is a description of the epidemiology and management of late preterm pregnancy.Late Preterm Birth: Management DilemmasCynthia Gyamfi-Bannerman10.1016/j.ogc.2011.12.005Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-23545http://www.obgyn.theclinics.com/article/PIIS088985451100129X/abstract?rss=yesFor nearly three decades, the preterm birth rate has been steadily increasing in the United States, rising by more than 30% during this time period. However, after peaking at 12.8% of all births in 2006, the preterm birth rate has declined for three consecutive years, to 12.18% in 2009. As preterm birth can result in serious long-term medical and developmental problems, with tremendous individual, family, and societal cost, this represents a most welcome trend. Meeting the Healthy People 2020 goal of an 11.4% rate of preterm birth may now be possible.Antenatal Corticosteroids in the Management of Preterm Birth: Are We Back Where We Started?Clarissa Bonanno, Ronald J. Wapner10.1016/j.ogc.2011.12.006Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-24763http://www.obgyn.theclinics.com/article/PIIS0889854511001306/abstract?rss=yesPreterm labor or premature rupture of the membranes (PROM) continue to account for the majority of the nearly 500,000 preterm births that occur in the United States each year, and are of particular importance because of the resultant perinatal morbidity and mortality, and the potential for long-term sequelae in these infants. In many cases, the inciting cause of preterm delivery remains unknown; however, intrauterine infection and inflammation have long been specifically linked to preterm birth, especially that occurring remote from term. In both preterm labor and PROM, ascending bacterial colonization of the decidua is believed to be a common inciting event. Unfortunately, strategies to prevent preterm birth through administration of antibiotics to asymptomatic women have met with limited success, and have in some cases led to an increased risk of prematurity. Because of this, attention has been given to antibiotic treatment of pregnancies complicated by acute preterm labor or after preterm PROM with the goal of prolonging pregnancy to allow further in utero development of the fetus. In this article, antibiotic therapy as an adjunct to the treatment of preterm labor and PROM for this indication is considered. Although there is considerable overlap between the clinical spectrum of preterm labor and preterm PROM, these entities are considered separately.Antibiotics in the Management of PROM and Preterm LaborBrian Mercer10.1016/j.ogc.2011.12.007Obstetrics and Gynecology Clinics 39, 1 (2012)2012-01-27Obstetrics and Gynecology Clinics2012-01-27391S0889-8545(11)X0006-26576http://www.obgyn.theclinics.com/article/PIIS0889854511001264/abstract?rss=yesPreterm birth is the leading cause of perinatal morbidity and mortality and leads to significant health care costs annually. Despite numerous advances in the care of obstetrical patients, the incidence of preterm birth in the United States is at an all-time high and may be on the rise given current trends of advancing maternal age, maternal medical conditions, assisted reproductive technology, and multiple gestations. Neonatal morbidity is strongly associated with gestational age at birth with adverse neonatal outcomes occurring in 77% of those born at 24 to 27 weeks' gestation compared with only 2% born at or beyond 34 weeks. Therefore, prevention of preterm birth and its associated neonatal morbidity and mortality are major world-wide concerns and a significant focus for obstetrical research.Tocolytic Therapy for Acute Preterm LaborAdi Abramovici, Jessica Cantu, Sheri M. Jenkins10.1016/j.ogc.2011.12.003Obstetrics and Gynecology Clinics 39, 1 (2012)2012-01-06Obstetrics and Gynecology Clinics2012-01-06391S0889-8545(11)X0006-27787http://www.obgyn.theclinics.com/article/PIIS0889854511001252/abstract?rss=yesIt is often said that the 2 key decisions that obstetricians routinely make address the questions: When is the best time to deliver? and Through what mode should the delivery be undertaken? Ideally, delivery should occur at term. Traditionally, “term birth” refers to any birth between 37 weeks and 0 days of gestation and 41 weeks and 6 days. However, data suggesting heterogeneity in outcomes within this group has led many to reconsider the definition of a “term birth.” As a result, term births may be subgrouped into 2 categories, “early” term births and “full” term births. Early term births encompass neonates born between 37 and 0/7 weeks gestation and 38 6/7 weeks gestation; full-term deliveries are those that occur between 39 and 0/7 weeks gestation and 41 6/7 weeks gestation (births occurring beyond this period are postdate or postterm). Some providers and patients may assume that optimal outcomes occur uniformly “at term,” whereas births at 37 or 38 weeks are associated with worse outcomes compared with those at 39 to 40 weeks. Therefore, the “early term” designation draws appropriate attention to the potential for adverse outcomes and the need to carefully consider the indication for delivery at term but before 39 weeks. Although early term deliveries occurring spontaneously or that are necessary to avoid maternal or fetal complications are unavoidable, it is important to limit the frequency of early births by induction or scheduled cesarean without medical or obstetric reasons. These births contribute to the rising rate of induction and cesarean delivery in the United States and to the ongoing reduction in mean gestational age at delivery. For example, the rates of cesarean delivery in the United States rose from 20.7% in 1996 to 31.8% in 2007, and this number is expected to continue to increase. A main reason for this increase is an increase in the number of primary cesareans and the decline in a trial of labor after cesarean. Inductions of labor have also increased in the United States, from 9.5% in 1990 to 22.5% in 2006. A significant proportion of these inductions and cesareans are elective, and may even be scheduled solely for patient or provider convenience.Early Term Births: Considerations in ManagementLuisa Wetta, Alan T.N. Tita10.1016/j.ogc.2011.12.002Obstetrics and Gynecology Clinics 39, 1 (2012)2012-01-06Obstetrics and Gynecology Clinics2012-01-06391S0889-8545(11)X0006-28997http://www.obgyn.theclinics.com/article/PIIS0889854512000125/abstract?rss=yesIndex10.1016/S0889-8545(12)00012-5Obstetrics and Gynecology Clinics 39, 1 (2012)2012-03-01Obstetrics and Gynecology Clinics2012-03-01391S0889-8545(11)X0006-299105