Navigating preterm birth: a modern approach to enhancing neonatal outcomes. From Latvia’s success to global solutions

Preterm birth (PTB), defined as delivery before 37 weeks of gestation, is the leading cause of neonatal death worldwide. Latvia, with a PTB rate of 5.45%, offers a useful model for understanding outcomes. This paper discusses a phenotype-based approach to PTB prevention, focusing on underlying mechanisms such as cervical insufficiency, infection, inflammation, and hormonal or genetic factors. The use of second-trimester transvaginal ultrasound enables early detection of a short cervix and the implementation of interventions such as vaginal progesterone and cerclage. Genomic studies indicate that up to 67% of women with cervical insufficiency carry rare variants in genes involved in collagen structure or progesterone pathways, supporting a multifactorial etiology. Vaginal microbiota alterations and intra-amniotic inflammation also contribute to PTB risk, highlighting the need for integrated molecular and microbial screening. Management includes targeted antibiotic therapy, which can resolve inflammation in up to 75% of cases and prolong pregnancy. When PTB is imminent, corticosteroids, magnesium sulfate, early referral, and adherence to golden hour protocols are essential. Delivery at experienced centers can reduce neonatal mortality by 50% in births before 32 weeks. Cesarean delivery may lower perinatal risk, particularly in cases of breech presentation. Europe should adopt unified standards for prevention and care, strengthen referral systems, and develop monitoring networks. Every preterm birth is an opportunity for personalized care; every baby counts.