Antenatal care of women with previous preterm delivery

Preterm delivery (PTD), caused by preterm labour (PTL), preterm prelabour rupture of membranes (PPROM) or cervical incompetence, is associated with significant perinatal morbidity and mortality and maternal morbidity. Importantly, these conditions are also associated with a recurrence risk in subsequent pregnancies: 20–35% for PTD, 25% for PTL and 20% for PPROM. However, there is controversy on the optimum antenatal management of women identified to be at high risk of PTD based on these historical risk factors. An individualized risk assessment approach by combining sociodemographic factors, cervical ultrasonography, fetal fibronectin and vaginal bacteriological colonization, has improved our ability to predict women at risk of PTD. However, there are only a few proven treatment options to prevent PTL and PPROM. This article presents an evidence-based overview and suggests an antenatal management plan for women with previous PTD before they present with PTL or PPROM.