Recent advances in the prevention and treatment of preterm labour: Oxytocin antagonists and the silicone (Arabin) pessary

Preterm birth may be spontaneous or medically indicated for maternal or fetal reasons. Around 20-25% of preterm births (PTB) follow preterm premature rupture of the membranes (PPROM), however the cause of preterm labour is often unknown. It may represent early maturation and activation of the normal labour process or it may be precipitated by pathological causes. The normal process of labour has a diurnal variation with more deliveries occurring at night. Evidence demonstrating that the diurnal variation persists in preterm deliveries suggest that at least a proportion are due to early maturation of the normal process and the logical assumption is that these may be amenable to prevention or effective treatment. Whatever the cause of preterm delivery, there appears to be a common pathway resulting in activation of inflammatory processes. It is important to distinguish the physiological and pathological causes of preterm labour and not to assume that all inflammation is pathological. The distinction is clinically important since pathological causes may be associated with an adverse intrauterine environment, which would be a contraindication to delaying delivery.