Prevention of preterm (premature) birth (PTB) remains a significant healthcare challenge, despite the recent development and implementation of a range of obstetric management approaches and interventions. Part of the difficulty in preventing PTB lies in the fact that it is not a single disease with a single cause – there are many different causes, many of which are hard to diagnose and even harder to treat. However, one of the most common and important causes, responsible for the early birth of the most premature and at-risk infants, is potentially treatable - intrauterine infection.
After decades of research, we now understand how bacteria from the genital tract ascend through the cervix and infect the amniotic cavity and fetus, triggering a local inflammatory response which activates the pathways leading to preterm labour and delivery. However, attempts to prevent or treat the infection, and block the damaging effects of inflammation in the fetus, have not been particularly successful and have not been widely accepted in obstetric practise.
As part of the WA Preterm Birth Prevention Initiative, we have been exploring new ways of identifying and treating women to prevent infection/inflammation-driven PTB. We have recently developed a test that identifies women at risk of intrauterine infection, so that they can be treated with antibiotics; we have also identified a novel and highly-effective antibiotic which appears to be ideal for treating and preventing intrauterine infection. Finally, we have evaluated a number of drugs that could be useful in blocking inflammation in women in preterm labour, as exposure to inflammation in-utero can cause damage to the fetal brain and other organs.
In this talk I will provide an overview of the infection-inflammation-labour process and discuss the key issues that need to be addressed when developing innovative and effective treatment and prevention programs. I will present the latest findings from our studies and those from others in the field, regarding exciting new interventions and pharmacological strategies for preventing