Question:

What are the most common and effective interventions for the prevention of premature labor with a history of preterm premature rupture of membranes (PPROM) in a previous pregnancy with no known cause? 

Answered by OB-GYN Teresa Berg, MD:

Preterm birth is currently defined as deliveries between 20 and 37 weeks of gestation. There are two main categories: spontaneous preterm birth (preterm labor, preterm premature rupture of membranes and cervical insufficiency) and indicated preterm birth. From the standpoint for fetal risk it is further divided into late preterm birth (34 to 37 weeks) and early preterm birth (<34 weeks). In 2019, in the United States, the rate of preterm birth was 10.2%. 
 
Spontaneous preterm birth has some risk factors that could be altered in some women. These include low weight of mom at the beginning of the pregnancy, smoking or vaping and less than 18 months between the delivery of one baby and the next pregnancy. Events during the pregnancy that are risk factors include vaginal bleeding, bladder infections, infections such as yeast infections and poor gum health. The strongest predictor of preterm birth is a history of preterm birth.  
 
Cervical length monitoring from 16 to 24 weeks has been demonstrated be effective when the finding of a short cervix is treated vaginal progesterone or a stitch in the cervix called a cerclage, depending on how short the cervix is on ultrasound measurement. Progesterone shots can be used in some women for the prevention of recurrent preterm birth associated with PPROM or spontaneous preterm labor. 
 
The American College of Obstetricians and Gynecologists recommend evaluation after a preterm birth with either preconception counseling or early pregnancy counseling to identify risk factors, discuss those that may be modifiable and to develop a plan through shared decision making for the treatment and care in the next pregnancy. 
 
 Reference: ACOG Practice Bulletin No. 234, Prediction and Prevention of Spontaneous Preterm Birth.