الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Conclusions & Levels of Evidence 1. Preterm birth is a significant perinatal health problem across the globe, not only in terms of associated mortality but also with regard to short- and long-term morbidity and financial implications for health-care systems (I a ).
2. Prior spontaneous preterm delivery is highly associated with recurrence in the current gestation (II b ).
3. There is not sufficient evidence to recommend use fetal fibronectin testing as a method for reducing the risk of preterm birth (I a ).
4. There is evidence that infection screening and treatment programs in pregnant women before 20 weeks gestation reduce preterm birth and preterm low birth weights ( I a ).
5. Combined measurement of CL and levels of cervical and plasma Nox ( nitric oxide ) could help identify women undergoing asymptomatic PTL who are at increased risk of PTD (II b ).
6. However antibiotic treatment can eradicate bacterial vaginosis in pregnancy, the overall risk of PTB was not significantly reduced ( I a ).
7. The use of progesterone is associated with benefits in infant health following administration in women considered to be at increased risk of preterm birth ( I a ).
8. Vaginally administrated progesterone was nearly as equally effective as intra muscular progesterone in the prevention of PTL in women at risk (II b ).
9. There is not enough high quality evidence to show that dietary magnesium supplementation during pregnancy is beneficial ( I a ).
10. Prostaglandin inhibitors and calcium channel blockers had the highest probability of delaying delivery and improving maternal and neonatal outcomes ( I a ).
11. Indomethacin was less effective than nifedipine for the fast treatment of preterm labor. For women who responded to treatment within 2 hours, however, the delaying of delivery by indomethacin was similar to that by nifedipine ( I b ).
12. Nifedipine is superior to β2-adrenergic-receptor agonists and magnesium sulfate for tocolysis in women with preterm labor ( I a ).
13. The use of Subcutaneous terbutaline significantly prolongs pregnancy, decreases serious neonatal complications, and reduces the duration of hospitalization for both mother and infant, as well as neonatal costs (II b ).
14. Although transdermal nitroglycerin appears to be more effective than b2-adrenergic receptor agonists, the current evidence does not support its routine use as a tocolytic agent for the treatment of preterm labor ( I a ).
15. Compared with no treatment, cervical cerclage reduces the incidence of preterm birth in women at risk of recurrent preterm birth without statistically significant reduction in perinatal mortality or neonatal morbidity and uncertain long-term impact on the baby ( I a ).
16. Compared with no treatment, cervical cerclage reduces the incidence of preterm birth in women at risk of recurrent preterm birth without statistically significant reduction in perinatal mortality or neonatal morbidity and uncertain long-term impact on the baby ( I a ).
17. The success rates of late second trimester emergency cerclage, in experienced hands and in absence of other risk factors like infection, are encouraging with improved prognosis. Finally, the modified Shirodkar technique yielded excellent results (II b ).
18. Multiple courses of Antenatal Corticosteroids that are initiated at <29 weeks’ gestation may have increased benefit compared with risks ( I a ).
19. Antenatal Corticosteroids reducethe need for exogenous surfactant, and the need for endotracheal tube insertion at birth in very low birth weight premature infants (II b).
20. Administration of a single rescue course of ACS before 33 weeks improves neonatal outcome (II b ).
21. There is significant decrease in fetal middle cerebral artery impedance at 72 h after maternal administration of the first dose of dexamethasone (II b ).
22. Cervical length assessment and obstetric history but not fetal fibronectin or biomarkers were useful in the risk stratification of women identified to be at greatest risk for spontaneous preterm birth (II b ).
23. The knowledge of cervical length (CL) and fetal fibronectin (FFN) was associated with reduction in length of evaluation in women with CL ˃ 30 mm and in incidence of spontaneous preterm birth (SPTB) in all women with preterm labour (PTL) (II b ).
24. Selective use of fetal fibronectin detection after cervical length measurement is more specific than cervical length and as effective as fetal fibronectin assays in the entire population of women in preterm labor for predicting preterm birth (II b ).
25. Elective delivery in women with PPROM can be associated with decreased neonatal morbidity compared to spontaneous labor (II b ).
26. Rates of neonatal intensive care unit admission, length of stay, and neonatal morbidities are significantly higher in late preterm as compared with term births (II b ).
27. Neonatal outcome was mainly affected by prematurity rather than by preterm premature rupture of membranes (II b ).
28. Prolonged intake of tocolytic MgSO4 is associated with a higher maternal morbidity rate (II b ).
29. Breech presentation in preterm delivery is an independent risk factor for neonatal mortality after simultaneous adjustment for birthweight, chorioamnionitis and placental pathology (II b ).
30. Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation (I a ).
31. The lower neonatal mortality after CS supports a policy of caesarean delivery of the preterm breech (II b ).
Recommendations
• Screening programs for genitourinary infections in women who are at high risk before 20 wk, help reduce the morbidity and mortality associated with PTB
• Progesterone should be given to all pregnant women who are at high risk for PTL.
• Vaginally admininstered prgesterone is as equal as IM one.
• Nifedipine is more suitable and effective, than Indomethacin, for FAST treatment of preterm labour.
• Nifedipine is superior to β agonists and MgSO4 for tocolysis in women with preterm labour.
• Atosiban, an oxytocin receptor antagonist, is very effective in treating preterm labour,but is very costy enough.
• Transdermal nitroglycerine shouldn’t be routinely used as a tocolytic agent for preterm labour.
• Cervicometry is very helpful in prediction of PTB. 70 % of cases with CL less than 20mm, will develop PTL and 30 % won’t.
• Cervical cerclage reduces the incidence of preterm birth in women at risk of recurrent preterm birth.
• Multiple courses of Antenatal Corticosteroids initiated before 29 wks have increased benefits compared to risks.
• Breech presentation is an independent risk factor for neonatal mortality, after simultaneous adjustment for birthweight, chorioamnionitis and placental pathology.
• Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation.
English Summary
• Prior spontaneous preterm delivery is highly associated with recurrence in the current gestation, specially the presence of genital or genito-urinary infection.
• There is evidence that infection screening and treatment programs in pregnant women before 20 weeks gestation reduce preterm birth and preterm low birth weights. Future trials should evaluate the effects of types of infection screening program and the costs of introducing an infection screening program.
• There is not sufficient evidence to recommend use fetal fibronectin testing as a method for reducing the risk of preterm birth.
• Combined measurement of cervical length and levels of cervical and plasma Nox ( nitric oxide ) could help identify women undergoing symptomatic preterm labour who are at increased risk of preterm delivery.
• The use of progesterone is associated with benefits in infant health following administration in women considered to be at increased risk of preterm birth due either to a prior preterm birth or where a short cervix has been identified on ultrasound examination.
• Progesterone was associated with a statistically significant reduction in the risk of perinatal mortality.
• Vaginally administrated progesterone was nearly as equally effective as intra muscular progesterone in the prevention of preterm labour.
• There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women at high risk of preterm labour with a singleton pregnancy.
• There is not enough high quality evidence to show that dietary magnesium supplementation during pregnancy is beneficial.
• Prostaglandin inhibitors and calcium channel blockers had the highest probability of delaying delivery and improving neonatal and maternal outcomes.
• Nifedipine is superior to β2-adrenergic-receptor agonists and magnesium sulfate for tocolysis in women with preterm labor.
• Terbutaline and nifedipine appear to be equally effective in their tocolytic action. However, nifedipine did have the advantage of ease of administration. It also had significantly less effect on the fetal heart rate.
• Atosiban is cost saving versus betamimetics in the treatment of preterm labour from the payer, hospital and combined perspectives.
• Compared with no treatment, cervical cerclage reduces the incidence of preterm birth in women at risk of recurrent preterm birth without statistically significant reduction in perinatal mortality or neonatal morbidity and uncertain long-term impact on the baby.
• It remains unclear whether one corticosteroid (or one particular regimen) has advantages over another. Dexamethasone may have some benefits compared with betamethasone such as less IVH, and a shorter length of stay in the NICU.
• Multiple courses of ACS that are initiated at <29 weeks’ gestation may have increased benefit compared with risks.
• ACS reduces the need for exogenous surfactant, and the need for endotracheal tube insertion at birth in VLBW premature infants.
• Administration of a single rescue course of ACS before 33 weeks improves neonatal outcome without apparent increased short-term risk.
• There is significant decrease in fetal middle cerebral artery impedance at 72 h after maternal administration of the first dose of dexamethasone.
• Neonates with multiple-dose ACS had lower incidence of surfactant use and lower rate of intubation than neonates without ACS.
• Rates of neonatal intensive care unit admission, length of stay, and neonatal morbidities are significantly higher in late preterm as compared with term births.
• Providing additional placental blood to the preterm baby by either delaying cord clamping for 30 to 120 seconds, rather than early clamping, seems to be associated with less need for transfusion, better circulatory stability, less intraventricular haemorrhage (all grades) and lower risk for necrotising enterocolitis.
• There is not enough evidence to evaluate the use of a policy of planned immediate caesarean delivery for preterm babies.
• Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation.
• The lower neonatal mortality after CS supports a policy of caesarean delivery of the preterm breech.