ABSTRACT
The prevention of preterm delivery (PTD) is a major desiderate in contemporary obstetrics
and a societal necessity. The means to achieve this goal remain elusive, and the research
efforts have been punctuated by several ineffective intervention proposals. More recently,
new areas of proposed preventive strategy have arisen, focusing on cervical competence,
subclinical infection, and hormonal effects. This review, based on a comprehensive
and unbiased review of the available literature, will address the rationale and current
status of these new concepts of significant clinical interest. We will describe the
microcosm of thought and research dedicated to the prevention of PTD during the last
10 years, and the arduous efforts to establish a linkage between predictive observations
and therapeutic hypotheses. In its first part, the review will discuss the recently
emerging view that regardless of the preterm labor etiology, a common pathway is eventually
reached, reflected in cervical changes. The new concept of functional cervical insufficiency
is addressed from the perspective of cervical assessment by ultrasound. Although the
existing research has not accurately quantified yet the usefulness of ultrasound cervical
examination, the technique has become commonplace. Several recent studies have demonstrated
a continuum of risk between shorter cervix on ultrasound and higher rate of PTD, leading
to the hypothetical argument that women with short cervix on ultrasound might benefit
from cervical cerclage. Observational and randomized clinical trials of cerclage as
a modality of pregnancy prolongation have provided conflicting results. The relative
paucity of data and the conflicting nature of the available evidence dictate caution
whenever decisions for cervical monitoring or intervention are made.
KEYWORDS
Preterm delivery - prediction - prevention - cervical insufficiency - cervical length
- cerclage
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