The standard risk factors for preterm birth are compiled in the article by Berger et al. (1). The authors note that, despite intensive preventive efforts, the risk rate for preterm births has remained unchanged in the past 10 years.
This may be due to the fact that when developing preventive strategies, hematologic and vascular risks, such as the von Willebrand disease or placental insufficiencies (2), have largely been ignored. Preeclampsia often occurs in late pregnancy and can be detected by the presence of a notch in detailed diagnostic examinations in the 22nd gestation week; nonetheless, the article does not mention that administration of either acetylsalicylic acid (ASA) before the 16th gestation week (3) or after the 20th gestation week (4), or low molecular weight heparin, leads to reduction of risk.
Additionnally, neither placental insufficiency or microcirculatory disorders as risk factors nor its treatments were mentioned in the article, although around 30% of pregnant women suffer from it to varying degrees. In these cases, administration of magnesium, drinking a volume of 2 to 3 liters, and if necessary, administration of low molecular weight heparin is advisable, as these measures can significantly increase placental blood flow. A study is currently being conducted with pentaerithrityl tetranitrate to test its effectiveness in preventing fetal growth restriction (2).
Unfortunately, there was no mention of the HELLP syndrome, which, like preeclampsia, can be prevented by ASA and low molecular weight heparin in a subsequent pregnancy (1, 2).
Footnotes
Conflict of interest statement
The author declares that no conflict of interest exists.
References
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