PRETERM BIRTH PREVENTION: IDENTIFY RISK EARLY 2 KEY EVIDENCE-BASED MESSAGES 1. Identify women at risk of spontaneous preterm birth. - Previous spontaneous preterm birth is an important risk factor for recurrence. - Transvaginal cervical length assessment between 18–24 weeks helps identify a short cervix. - A cervical length of 25 mm or less in the mid-trimester is considered short. - Previous cervical surgery, uterine anomalies and multiple pregnancy also require appropriate risk assessment. 2. Use evidence-based preventive interventions. - In singleton pregnancies with a short cervix, vaginal progesterone reduces the risk of preterm birth. - Consider vaginal progesterone when cervical length is 20 mm or less before 24 weeks, even without a previous preterm birth. - Cerclage may be appropriate in selected women with a previous spontaneous preterm birth and a short cervix. - Routine bed rest is not recommended for prevention of preterm birth. KEY TAKE-HOME MESSAGE Preventing preterm birth starts with identifying risk early—not waiting for symptoms. Mid-trimester cervical length assessment, appropriate progesterone use and timely cerclage in selected patients can improve pregnancy outcomes. IMPORTANT CLINICAL PEARLS - Do not prescribe vaginal progesterone routinely when cervical length is normal solely because of previous preterm birth, according to ACOG guidance. - 17-OHPC injections are no longer recommended for prevention of recurrent preterm birth. - Management of twin pregnancies requires a separate evidence-based approach. Evidence sources 1. SMFM — Consult Series #70: Management of Short Cervix (2024). 2. ACOG — Updated Progestogen Guidance (2025). 3. VVOG Clinical Guidance on Preterm Birth Prevention (2025). #SUNLEAFWOMENSCARE #PRETERMBIRTHPREVENTION #PRETERMDELIVERY #CERVICALLENGTH #SHORTCERVIX #VAGINALPROGESTERONE #CERVICALCERCLAGE #HIGH RISK PREGNANCY #OBSTETRICS #MATERNALHEALTH #PREGNANCYCARE #SURAT #SART HANA #VARACHHA