32. More than 1/2 of patients who deliver preterm have no risk factors More than 2/3 of patients with traditional risk factors do not deliver preterm Most important traditional risk factor is preterm delivery in a prior pregnancy
46. Are there any therapeutic interventions to prevent SPTB?
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50. Cerclage for dilated cervix with membranes at or beyond the external os Althusius et al, Am J Obstet Gynecol 2003 Cerclage & Indomethacin (n=13) Bedrest alone (n=10) Prolongation (weeks) 7.7 3.0 Neonatal survival 56% 28% Preterm birth <34 weeks 54% 100% Composite neonatal morbidity 62% 100%
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53. Multicenter Randomized Trial of Cerclage For Preterm Birth Prevention In High-Risk Women With Shortened Mid-Trimester Cervical Length (Owen J, Abst #4, Am J Obstet Gynecol Suppl Dec 2008) Reduction in PTB < 35 wks in cerclage patients OR (95% CI) If CL < 15 mm 0.23 (0.08, 0.66) If CL 16-24 mm 0.84 (0.49, 1.40) P=0.05 CONCLUSION: Cerclage will mostly benefit high-risk women with mid-trimester CL < 15 mm (77% reduction in PTB rate)