Historically efforts have been primarily aimed to improve survival and health of<unk>  infants (tertiary intervention). Such efforts, however, have not reduced the incidence of<unk> . Increasingly primary interventions that are directed at all women, and secondary intervention that reduce existing risks are looked upon as measures that need to be developed and implemented to prevent the health problems of premature infants and children. Smoking bans are effective in decreasing<unk> s. Different strategies are used in the administration of prenatal care, and future studies need to determine if the focus can be on screening for high-risk women, or widened support for low-risk women, or to what degree these approaches can be merged. Before pregnancy Adoption of specific professional policies can immediately reduce risk of<unk>  as the experience in assisted reproduction has shown when the number of embryos during embryo transfer was limited. Many countries have established specific programs to protect pregnant women from hazardous or night-shift work and to provide them with time for prenatal visits and paid pregnancy-leave. The EUROPOP study showed that<unk>  is not related to type of employment, but to prolonged work (over 42 hours per week) or prolonged standing (over 6 hours per day). Also, night work has been linked to<unk> . Health policies that take these findings into account can be expected to reduce the rate of<unk> . Preconceptional intake of folic acid is recommended to reduce birth defects. There is also some evidence that folic acid supplement preconceptionally (before becoming pregnant) may reduce premature birth. Reducing smoking is expected to benefit pregnant women and their offspring. During pregnancy Self-care methods to reduce the risk of<unk>  include proper nutrition, avoiding stress, seeking appropriate medical care, avoiding infections, and the control of<unk>  risk factors (e.g. working long hours while standing on feet, carbon monoxide exposure, domestic abuse, and other factors). Reducing physical activity during pregnancy has not been shown to reduce the risk of a<unk> . Healthy eating can be instituted at any stage of the pregnancy including nutritional adjustments and consuming suggested vitamin supplements. Calcium supplementation in women who have low dietary calcium may reduce the number of negative outcomes including<unk> , pre-eclampsia, and maternal death. The World Health Organization (WHO) suggests 1.5–2 g of calcium supplements daily, for pregnant women who have low levels of calcium in their diet. Supplemental intake of C and E vitamins have not been found to reduce<unk>  rates. While periodontal infection has been linked with<unk> , randomized trials have not shown that periodontal care during pregnancy reduces<unk>  rates. Smoking cessation has also been shown to reduce the risk. The use of personal at home uterine monitoring devices to detect contractions and possible<unk> s in women at higher risk of having a<unk>  baby have been suggested. These home monitors may not reduce the number of<unk> s, however, using these devices may increase the number of unplanned antenatal visits and may reduce the number of babies admitted to special care when compared with women receiving normal antenatal care. Support from medical professionals, friends, and family during pregnancy may be beneficial at reducing caesarean birth and may reduce prenatal hospital admissions, however, these social supports alone may not prevent<unk> . Screening during pregnancy Screening for asymptomatic bacteriuria followed by appropriate treatment reduces pyelonephritis and reduces the risk of<unk> . Extensive studies have been carried out to determine if other forms of screening in low-risk women followed by appropriate intervention are beneficial, including screening for and treatment of Ureaplasma urealyticum, group B streptococcus, Trichomonas vaginalis, and bacterial vaginosis did not reduce the rate of<unk> . Routine ultrasound examination of the length of the cervix may identify women at risk of<unk>  labour and tentative evidence suggests ultrasound measurement of the length of the cervix in those with<unk>  labor can help adjust management and results in the extension of pregnancy by about 4 days. Screening for the presence of fibronectin in vaginal secretions is not recommended at this time in women at low risk of<unk> . Reducing existing risks Women are identified to be at increased risk for<unk>  on the basis of their past obstetrical history or the presence of known risk factors. Preconception intervention can be helpful in selected patients in a number of ways. Patients with certain uterine anomalies may have a surgical correction (i.e. removal of a uterine septum), and those with certain medical problems can be helped by optimizing medical therapies prior to conception, be it for asthma, diabetes, hypertension, and others. Multiple pregnancies In multiple pregnancies, which often result from use of assisted reproductive technology, there is a high risk of<unk> . Selective reduction is used to reduce the number of fetuses to two or three. Reducing indicated<unk>  A number of agents have been studied for the secondary prevention of indicated<unk> . Trials using low-dose aspirin, fish oil, vitamin C and E, and calcium to reduce preeclampsia demonstrated some reduction in<unk>  only when low-dose aspirin was used. Even if agents such as calcium or antioxidants were able to reduce preeclampsia, a resulting decrease in<unk>  was not observed. Reducing spontaneous<unk>  Reduction in activity by the mother—pelvic rest, limited work, bed rest—may be recommended although there is no evidence it is useful with some concerns it is harmful. Increasing medical care by more frequent visits and more education has not been shown to reduce<unk>  rates. Use of nutritional supplements such as omega-3 polyunsaturated fatty acids is based on the observation that populations who have a high intake of such agents are at low risk for<unk> , presumably as these agents inhibit production of proinflammatory cytokines. A randomized trial showed a significant decline in<unk>  rates, and further studies are in the making. Antibiotics While antibiotics can get rid of bacterial vaginosis in pregnancy, this does not appear to change the risk of<unk> . It has been suggested that chronic chorioamnionitis is not sufficiently treated by antibiotics alone (and therefore they cannot ameliorate the need for<unk>  delivery in this condition). Progestogens Progestogens—often given in the form of vaginal progesterone or hydroxyprogesterone caproate—relax the uterine musculature, maintain cervical length, and possess anti-inflammatory properties; all of which invoke physiological and anatomical changes considered to be beneficial in reducing<unk> . Two meta-analyses demonstrated a reduction in the risk of<unk>  in women with recurrent<unk>  by 40–55%. Progestogen supplementation also reduces the frequency of<unk>  in pregnancies where there is a short cervix. A short cervix is one that is less than 25mm, as detected during a transvaginal cervical length assessment in the midtrimester. However, progestogens are not effective in all populations, as a study involving twin gestations failed to see any benefit. Despite extensive research related to progestogen effectiveness, uncertainties remain concerning types of progesterone and routes of administration. Cervical cerclage In preparation for childbirth, the woman's cervix shortens.<unk>  cervical shortening is linked to<unk>  and can be detected by ultrasonography. Cervical cerclage is a surgical intervention that places a suture around the cervix to prevent its shortening and widening. Numerous studies have been performed to assess the value of cervical cerclage and the procedure appears helpful primarily for women with a short cervix and a history of<unk> . Instead of a prophylactic cerclage, women at risk can be monitored during pregnancy by sonography, and when shortening of the cervix is observed, the cerclage can be performed.
Preterm birth
Breech birth
Low birth weight
Multiple birth
Low Birth Weight
Stillbirth
Birth injury
Birth trauma 