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preterm delivery

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Preterm labour is defined as occuring before 37 weeks of gestation. This is the point where obstetrics and neonatal paediatrics firmly overlap. For an obstetrician looking after a woman in premature labour it is essential to involve the paediatricians. Co-operation between the two teams should be well-established by the time of birth.

Important information which may influence management includes:

  • circumstances that triggered labour
  • gestational age
  • prenatal drugs

Preterm birth is the single biggest cause of neonatal mortality and morbidity in the UK

  • over 52,000 babies (around 7.3% of live births) in England and Wales in 2012 were born preterm (that is, before 37+0 weeks of pregnancy)
    • been no decline in the preterm birth rate in the UK over the last 10 years

Babies born preterm have high rates of neonatal and infant mortality, and the risk of mortality increases as gestational age at birth decreases

  • babies who survive preterm birth have increased rates of disability
  • UK studies comparing cohorts born in 1995 and 2006 have shown improved rates of survival (from 40% to 53%) for extreme preterm births (born between 22 and 26 weeks)
  • rates of disability in survivors were largely unchanged over this time period
    • the major long-term consequence of prematurity is neurodevelopmental disability
      • although the risk for the individual child is greatest for those born at the earliest gestational ages, the global burden of neurodevelopmental disabilities depends on the number of babies born at each of these gestations, and so is greatest for babies born between 32 and 36 weeks, less for those born between 28 and 31 weeks, and least for those born at less than 28 weeks gestation.

Around 75% of women giving birth preterm do so after preterm labour, which may or may not be preceded by preterm prelabour rupture of membranes

  • the remaining women giving birth preterm have an elective preterm birth when this is thought to be in the fetal or maternal interest (for example, because of extreme growth retardation in the baby or maternal conditions such as preeclampsia).



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