Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates in the United States. Unfortunately, preterm birth rates remain high despite current medical interventions such as progestogen supplementation and cerclage placement. Case management, which encompasses coordinated care aimed at providing a more comprehensive and supportive environment, is a key component in improving health and reducing costs in other areas of medicine. However, it has not made its way into the general lexicon and practice of obstetrical care. Case management intended for decreasing prematurity or ameliorating its consequences may include specialty clinics, social services, coordination of specialty services such as nutrition counseling, home visits or frequent phone calls by specially trained personnel, and other elements described herein. It is not currently included in nor is it advocated for as a recommended prematurity prevention approach in the American College of Obstetricians and Gynecologists or Society for Maternal-Fetal Medicine guidelines for medically indicated or spontaneous preterm birth prevention. Our review of existing evidence finds consistent reductions or trends toward reductions in preterm birth with case management, particularly among individuals with high a priori risk of preterm birth across systematic reviews, metaanalyses, and randomized controlled studies. These findings suggest that case management has substantial potential to improve the environmental, behavioral, social, and psychological factors with patients at risk of preterm birth.

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是否应将病例管理视为针对有早产风险的妊娠产科干预措施的一部分？

早产仍然是美国非异常新生儿发病和死亡的主要原因。不幸的是，尽管目前采取了补充孕激素和环扎术等医疗干预措施，但早产率仍然很高。病例管理包括旨在提供更全面和支持性环境的协调护理，是改善健康和降低其他医学领域成本的关键组成部分。然而，它尚未进入产科护理的一般词汇和实践中。旨在减少早产或改善其后果的病例管理可能包括专科诊所、社会服务、专业服务协调，例如营养咨询、经过专门培训的人员家访或频繁打电话，以及本文描述的其他要素。目前，美国妇产科医师学会或母胎医学协会针对有医学指征或自发性早产预防的指南中并未将其纳入也未提倡将其作为推荐的早产预防方法。我们对现有证据的审查发现，通过病例管理，早产现象持续减少或有减少的趋势，特别是在系统评价、荟萃分析和随机对照研究中，早产先验风险较高的个体中。这些发现表明，病例管理在改善有早产风险的患者的环境、行为、社会和心理因素方面具有巨大的潜力。