Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) – Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of Preterm Birth

Abstract

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups.

Methods Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus).

Recommendations Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.

Key words

preterm birth - preterm labor - cervical insufficiency - preterm premature rupture of membranes

• References/Literatur

• 1 Swiss-Paediatrics. Perinatale Betreuung an der Grenze der Lebensfähigkeit zwischen 22 und 26 vollendeten Schwangerschaftswochen. Online: http://www.swiss-paediatrics.org/sites/default/files/paediatrica/vol23/n1/pdf/10-12_0.pdf last access: 28.04.2019
• 2 Murray CJ, Vos T, Lozano R. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197-2223
• 3 IQTIG. Bundesauswertung zum Erfassungsjahr 2017 – Geburtshilfe Qualitätsindikatoren. Online: https://iqtig.org/downloads/auswertung/2017/16n1gebh/QSKH_16n1-GEBH_2017_BUAW_V02_2018-08-01.pdf last access: 28.04.2019
• 4 Zeitlin J, Mohangoo A, Delnord M. editors. report editors. The European Health Report 2010. Online: http://www.europeristat.com/reports/european-perinatal-health-report-2010.html last access: 28.04.2019
• 5 Institut für klinische Epidemiologie der Tirol Kliniken GmbH. Bericht Geburtenregister Östereich, Geburtsjahr 2016. Online: https://www.iet.at/data.cfm?vpath=publikationen210/groe/groe-jahresbericht-2016 last access: 28.04.2019
• 6 Bundesamt für Statistik. Gesundheit der Neugeborenen. Online: https://www.bfs.admin.ch/bfs/de/home/statistiken/gesundheit/gesundheitszustand/gesundheit-neugeborenen.html last access: 28.04.2019
• 7 Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science 2014; 345: 760-765
• 8 Hillier SL, Nugent RP, Eschenbach DA. et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med 1995; 333: 1737-1742
• 9 Meis PJ, Michielutte R, Peters TJ. et al. Factors associated with preterm birth in Cardiff, Wales. II. Indicated and spontaneous preterm birth. Am J Obstet Gynecol 1995; 173: 597-602
• 10 Murphy DJ. Epidemiology and environmental factors in preterm labour. Best Pract Res Clin Obstet Gynaecol 2007; 21: 773-789
• 11 Yi SW, Han YJ, Ohrr H. Anemia before pregnancy and risk of preterm birth, low birth weight and small-for-gestational-age birth in Korean women. Eur J Clin Nutr 2013; 67: 337-342
• 12 Schummers L, Hutcheon JA, Hernandez-Diaz S. et al. Association of Short Interpregnancy Interval With Pregnancy Outcomes According to Maternal Age. JAMA Intern Med 2018; 178: 1661-1670
• 13 Wetzka S, Gallwas J, Hasbargen U. et al. Einfluss von Konisation auf die Frühgeburtenrate und das perinatale Outcome: Eine retrospektive Analyse der Daten zur externen stationären Qualitätssicherung für die Erfassungsjahre 2009–2014. Geburtsh Frauenheilk 2018;
• 14 Kagan KO, Sonek J. How to measure cervical length. Ultrasound Obstet Gynecol 2015; 45: 358-362
• 15 Salomon LJ, Diaz-Garcia C, Bernard JP. et al. Reference range for cervical length throughout pregnancy: non-parametric LMS-based model applied to a large sample. Ultrasound Obstet Gynecol 2009; 33: 459-464
• 16 Iams JD, Goldenberg RL, Meis PJ. et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med 1996; 334: 567-572
• 17 Son M, Grobman WA, Ayala NK. et al. A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate. Am J Obstet Gynecol 2016; 214: 365.e1-365.e5
• 18 Berghella V, Baxter JK, Hendrix NW. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev 2013; (01) CD007235
• 19 Berghella V, Talucci M, Desai A. Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies?. Ultrasound Obstet Gynecol 2003; 21: 140-144
• 20 Owen J, Yost N, Berghella V. et al. Can shortened midtrimester cervical length predict very early spontaneous preterm birth?. Am J Obstet Gynecol 2004; 191: 298-303
• 21 Fox NS, Jean-Pierre C, Predanic M. et al. Short cervix: is a follow-up measurement useful?. Ultrasound Obstet Gynecol 2007; 29: 44-46
• 22 Dilek TU, Yazici G, Gurbuz A. et al. Progressive cervical length changes versus single cervical length measurement by transvaginal ultrasound for prediction of preterm delivery. Gynecol Obstet Invest 2007; 64: 175-179
• 23 Crane JM, Hutchens D. Follow-up cervical length in asymptomatic high-risk women and the risk of spontaneous preterm birth. J Perinatol 2011; 31: 318-323
• 24 Owen J, Yost N, Berghella V. et al. Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA 2001; 286: 1340-1348
• 25 Owen J, Hankins G, Iams JD. et al. Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 2009; 201: 375.e1-375.e8
• 26 Conde-Agudelo A, Romero R, Hassan SS. et al. Transvaginal sonographic cervical length for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol 2010; 203: 128.e1-128.e12
• 27 Lim AC, Hegeman MA, Huis In ʼT Veld MA. et al. Cervical length measurement for the prediction of preterm birth in multiple pregnancies: a systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol 2011; 38: 10-17
• 28 Romero R, Conde-Agudelo A, El-Refaie W. et al. Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol 2017; 49: 303-314
• 29 van ʼt Hooft J, van der Lee JH, Opmeer BC. et al. Pessary for prevention of preterm birth in twin pregnancy with short cervix: 3-year follow-up study. Ultrasound Obstet Gynecol 2018; 51: 621-628
• 30 Berghella V, Palacio M, Ness A. et al. Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 2017; 49: 322-329
• 31 Ness A, Visintine J, Ricci E. et al. Does knowledge of cervical length and fetal fibronectin affect management of women with threatened preterm labor? A randomized trial. Am J Obstet Gynecol 2007; 197: 426.e1-426.e7
• 32 Palacio M, Sánchez M, Cobo T. et al. Cervical length measurement to reduce length of stay in patients admitted because of pretermlabor. Prospective and randomized trial. Final results. Ultrasound Obstet Gynecol 2006; 28: 485
• 33 Alfirevic Z, Allen-Coward H, Molina F. et al. Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial. Ultrasound Obstet Gynecol 2007; 29: 47-50
• 34 Conde-Agudelo A, Papageorghiou AT, Kennedy SH. et al. Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysis. BJOG 2011; 118: 1042-1054
• 35 Melchor JC, Khalil A, Wing D. et al. Prediction of preterm delivery in symptomatic women using PAMG-1, fetal fibronectin and phIGFBP-1 tests: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 52: 442-451
• 36 Deshpande SN, van Asselt AD, Tomini F. et al. Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis. Health Technol Assess 2013; 17: 1-138
• 37 Abbott DS, Radford SK, Seed PT. et al. Evaluation of a quantitative fetal fibronectin test for spontaneous preterm birth in symptomatic women. Am J Obstet Gynecol 2013; 208: 122.e1-122.e6
• 38 Kuhrt K, Unwin C, Hezelgrave N. et al. Endocervical and high vaginal quantitative fetal fibronectin in predicting preterm birth. J Matern Fetal Neonatal Med 2014; 27: 1576-1579
• 39 Kuhrt K, Hezelgrave N, Foster C. et al. Development and validation of a tool incorporating quantitative fetal fibronectin to predict spontaneous preterm birth in symptomatic women. Ultrasound Obstet Gynecol 2016; 47: 210-216
• 40 Bruijn MM, Kamphuis EI, Hoesli IM. et al. The predictive value of quantitative fibronectin testing in combination with cervical length measurement in symptomatic women. Am J Obstet Gynecol 2016; 215: 793.e1-793.e8
• 41 Hezelgrave NL, Abbott DS, Radford SK. et al. Quantitative Fetal Fibronectin at 18 Weeks of Gestation to Predict Preterm Birth in Asymptomatic High-Risk Women. Obstet Gynecol 2016; 127: 255-263
• 42 Esplin MS, Elovitz MA, Iams JD. et al. Predictive Accuracy of Serial Transvaginal Cervical Lengths and Quantitative Vaginal Fetal Fibronectin Levels for Spontaneous Preterm Birth Among Nulliparous Women. JAMA 2017; 317: 1047-1056
• 43 Meis PJ, Klebanoff M, Thom E. et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003; 348: 2379-2385
• 44 Norman JE, Marlow N, Messow CM. et al. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet 2016; 387: 2106-2116
• 45 Ashoush S, ElKady O, AlHawwary G. et al. The value of oral micronized progesterone in the prevention of recurrent spontaneous preterm birth: a randomized controlled trial. Acta Obstet Gynecol Scand 2017; 96: 1460-1466
• 46 Dodd JM, Grivell RM, OBrien CM. et al. Prenatal administration of progestogens for preventing spontaneous preterm birth in women with a multiple pregnancy. Cochrane Database Syst Rev 2017; (10) CD012024
• 47 Crowther CA, Ashwood P, McPhee AJ. et al. Vaginal progesterone pessaries for pregnant women with a previous preterm birth to prevent neonatal respiratory distress syndrome (the PROGRESS Study): A multicentre, randomised, placebo-controlled trial. PLoS Med 2017; 14: e1002390
• 48 OʼBrien JM, Adair CD, Lewis DF. et al. Progesterone vaginal gel for the reduction of recurrent preterm birth: primary results from a randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 2007; 30: 687-696
• 49 Rai P, Rajaram S, Goel N. et al. Oral micronized progesterone for prevention of preterm birth. Int J Gynaecol Obstet 2009; 104: 40-43
• 50 da Fonseca EB, Bittar RE, Carvalho MHB. et al. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am J Obstet Gynecol 2003; 188: 419-424
• 51 Berghella V, MacKeen AD. Cervical length screening with ultrasound-indicated cerclage compared with history-indicated cerclage for prevention of preterm birth: A meta-analysis. Obstet Gynecol 2011; 118: 148-155
• 52 Saling E, Schumacher E. Total surgical cervical occlusion. Conclusions from data of several clinica, which use total surgical cervical occlusion. Z Geburtshilfe Neonatol 1996; 200: 82-87
• 53 Leitich H, Bodner-Adler B, Brunbauer M. et al. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 2003; 189: 139-147
• 54 Flynn CA, Helwig AL, Meurer LN. Bacterial vaginosis in pregnancy and the risk of prematurity: a meta-analysis. J Fam Pract 1999; 48: 885-892
• 55 Lamont RF. Advances in the Prevention of Infection-Related Preterm Birth. Front Immunol 2015; 6: 566
• 56 Kiss H, Petricevic L, Husslein P. Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery. BMJ 2004; 329: 371
• 57 Sangkomkamhang US, Lumbiganon P, Prasertcharoensuk W. et al. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database Syst Rev 2015; (02) CD006178
• 58 Subtil D, Brabant G, Tilloy E. et al. Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet 2018; 392: 2171-2179
• 59 Hollowell J, Oakley L, Kurinczuk JJ. et al. The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review. BMC Pregnancy Childbirth 2011; 11: 13
• 60 Moore E, Blatt K, Chen A. et al. Relationship of trimester-specific smoking patterns and risk of preterm birth. Am J Obstet Gynecol 2016; 215: 109.e106
• 61 Polakowski LL, Akinbami LJ, Mendola P. Prenatal smoking cessation and the risk of delivering preterm and small-for-gestational-age newborns. Obstet Gynecol 2009; 114: 318-325
• 62 IQWIG 2015: Abschlußbericht S13-02 Bakteriuriescreening bei Schwangeren. Online: https://www.iqwig.de/download/S13-02_Abschlussbericht_Bakteriuriescreening-bei-Schwangeren.pdf last access: 28.04.2019
• 63 Makrides M, Duley L, Olsen SF. Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction. Cochrane Database Syst Rev 2006; (03) CD003402
• 64 Middleton P, Gomersall JC, Gould JF. et al. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev 2018; (11) CD003402
• 65 Romero R, Nicolaides KH, Conde-Agudelo A. et al. Vaginal progesterone decreases preterm birth </= 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study. Ultrasound Obstet Gynecol 2016; 48: 308-317
• 66 Berghella V, Odibo AO, To MS. et al. Cerclage for short cervix on ultrasonography: Meta-analysis of trials using individual patient-level data. Obstet Gynecol 2005; 106: 181-189
• 67 Goya M, Pratcorona L, Merced C. et al. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet 2012; 379: 1800-1806
• 68 Saccone G, Maruotti GM, Giudicepietro A. et al. Effect of Cervical Pessary on Spontaneous Preterm Birth in Women With Singleton Pregnancies and Short Cervical Length: A Randomized Clinical Trial. JAMA 2017; 318: 2317-2324
• 69 Cruz-Melguizo S, San-Frutos L, Martinez-Payo C. et al. Cervical Pessary Compared With Vaginal Progesterone for Preventing Early Preterm Birth: A Randomized Controlled Trial. Obstet Gynecol 2018; 132: 907-915
• 70 Hui SY, Chor CM, Lau TK. et al. Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20 to 24 weeks: a randomized controlled trial. Am J Perinatol 2013; 30: 283-288
• 71 Nicolaides KH, Syngelaki A, Poon LC. et al. A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth. N Engl J Med 2016; 374: 1044-1052
• 72 Karbasian N, Sheikh M, Pirjani R. et al. Combined treatment with cervical pessary and vaginal progesterone for the prevention of preterm birth: A randomized clinical trial. J Obstet Gynaecol Res 2016; 42: 1673-1679
• 73 Dugoff L, Berghella V, Sehdev H. et al. Prevention of preterm birth with pessary in singletons (PoPPS): randomized controlled trial. Ultrasound Obstet Gynecol 2018; 51: 573-579
• 74 Palmer KT, Bonzini M, Bonde JP. et al. Pregnancy: occupational aspects of management: concise guidance. Clin Med 2013; 13: 75-79