Why should preterm births be rising?

Preterm birth is a major contributor to neonatal and infant mortality. Few interventions have improved outcome, and management remains an important challenge in modern obstetrics. A paper in this week's BMJ indicates that preterm delivery rates are increasing, which is a worrying prospect.1

Preterm deliveries account for fewer than 1 in 10 births but result in 75% of neonatal deaths and most neonatal intensive care admissions.2 Preterm birth has considerable impact on long term future health: 1 in 4 survivors born at less than 25 weeks' gestation have severe mental or physical disability.3 Those born at less than 28 weeks spend 85 times as long in hospital as term babies in the first five years of life, with substantial healthcare costs.4 Even beyond 32 weeks, when “neurologically intact” survival is good, educational and behavioural problems occur in 1 in 3 children at the age of 7. This type of morbidity is far …