Preterm birth Risk recognition and intervention effectiveness

Preterm birth is not a disease; it is a classification used to define the timing of birth relative to gestational age. It reflects when a birth occurs, not why it occurs, and is the outcome of various causes that can disrupt physiological gestation. The heterogeneity in preterm birth causes implies that a one-size-fits-all approach to its screening tools and interventions is not realistic. The dynamic interaction of individual risk factors complicates the prediction which risk factor(s) will exert the greatest impact, while others remain undetected, making a cause-targeted approach more challenging. Not all cases of preterm birth are attributable to cervical dysfunction, nor do they necessarily manifest with cervical shortening. By embracing preterm birth as an outcome with multiple causes, instead of a singular disease entity, universal cervical length measurement should become an essential part in preterm birth prevention as it is a valuable tool to detect cervical dysfunction. This thesis advocates for a comprehensive package of prevention strategies that addresses the full spectrum of biological causes of preterm birth, while acknowledging that many risk factors extend into the environmental and socio-economic domain and require a broader, systemic approach. We need to move away from the pursuit of a single one-tool-predicts all, or one-intervention-prevents all, as this could overlook the true potential of targeted strategies to address specific causes of preterm birth.