Prematurity: Relevant aspects in asymptomatic patients

Abstract

The objective of this chapter was to describe the most relevant aspects of prematurity in asymptomatic patients. Through a review of the literature, we will discuss the most effective strategies to predict and prevent prematurity in asymptomatic women with single or multiple pregnancies. Clinical predictions are greatly limited, and the use of cervical length measurements and biochemical markers for certain risk groups improves prediction strategies, although with limited sensitivity. Quantitative fibronectin testing has advantages, and its association with cervical length measurements improves predictive quality. Primary prevention should be undertaken in all patients. Single-pregnancy patients should be treated with progesterone, cerclage, or pessary, the latter having the least precise indication. In twin pregnancies, although the data are more conflicting, there seems to be specific possibilities for the use of progesterone, cerclage, and pessary. Great advances have been made in this field; however, only select subgroups of women seem to benefit from these results. Further studies are necessary to further explain conflicting data regarding the best prediction and prevention model for asymptomatic women, especially for patients considered at low risk.