REVIEW The effectiveness of medical interventions aimed at preventing preterm birth: A literature review Peeranan Wisanskoonwong * , Kathleen Fahy, Carolyn Hastie School of Nursing and Midwifery, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia Received 27 July 2010; received in revised form 13 December 2010; accepted 13 December 2010 This review was undertaken as part of a study seeking to find ways to reduce the preterm birth rate in Thailand where the rate is 11.4% of all births. 1 This rate is high by world stan- dards where the average is preterm birth rate is 9.6%. 2 Preterm birth is recognized by WHO 3 as one of the top 10 causes of death worldwide. Preterm birth is defined as one that occurs after 20 weeks and before 37 completed weeks’ gestation. 4,5 Women and Birth (2011) 24, 141—147 KEYWORDS Preterm birth; Cervical cerclage; Infections; Tocolysis; Progesterone; Meta-analysis Abstract Background: Preterm birth is a significant global health problem with serious short and long term consequences. This paper reviews the research literature to answer the question how effective are the medical interventions that aim to reduce the rates of preterm birth? Methods: A systematic search was carried out in CINAHL, Cochrane, Medline and Embase in relation to following medical treatments aimed at preventing preterm births: anti-infective medications, tocolytics, progesterone and cervical cerclage. The research underpinning each type of intervention is critically analysed in order to establish the validity of knowledge claims that are made for each type of intervention. Findings: In relation to reducing the rates of preterm births, anti-infectives are only effective in the presence of known infection. Screening for infections during pregnancy is ineffective. Tocolytic agents are not effective in decreasing the preterm birth rates. Progesterone seems to be effective in a select group of pregnant women at higher risk of preterm birth. Cervical cerclage plays a small and an occasional role in preventing some preterm births. Conclusions: This literature review demonstrates that medical interventions aimed at prevent- ing, not just delaying, preterm birth, are not effective at a population level. Providing holistic, antenatal midwifery care for women living in socio-economic disadvantage and/or with an increased risk of preterm birth seems to be a promising strategy to address the negative effects of the social determinants of disease and thus to reduce the rate of preterm births at an individual and a population level. # 2011 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved. * Corresponding author. Tel.: +61 02 49216651; fax: +61 02 49216301. E-mail address: c3053421@uon.edu.au (P. Wisanskoonwong). a va ila ble at ww w. scie nce dir ect. com jo u rn al h om ep age: w ww.els evier.c o m/lo c ate/wo mb i 1871-5192/$ — see front matter # 2011 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved. doi:10.1016/j.wombi.2010.12.002