Singapore updates guidelines for preterm birth management, shifting from crisis management to prevention

SINGAPORE: KK Women’s and Children’s Hospital (KKH), together with the College of Obstetrics and Gynaecology, has released updated national guidelines for the management of premature birth, marking the first comprehensive revision of its kind in Singapore.

The new guidelines, introduced by Minister of State Rahayu Mahzam, aim to standardise the screening, prevention and treatment of preterm birth across the healthcare system. A key shift is the move away from reactive, crisis-based care towards earlier identification and prevention, with the goal of improving outcomes for both mothers and infants.

Around 3,000 babies are born prematurely in Singapore each year. The country’s preterm birth rate has remained steady at 8.5 per cent, a figure higher than that seen in some developed regions in Asia.

Premature birth is associated with a range of long-term health challenges, particularly affecting the respiratory, neurological and developmental systems. These complications can place significant emotional and financial strain on families. The updated guidelines place strong emphasis on early risk assessment and timely intervention to reduce the likelihood of complications and the need for intensive neonatal care.

Under the recommendations, healthcare professionals are advised to carry out systematic risk assessments beginning at the first prenatal visit and continuing at key stages of pregnancy, including 11 to 13 weeks, 18 to 22 weeks, and at 24 weeks. The guidelines broaden the scope of assessment beyond women with a prior history of preterm birth to also include first-time mothers and those with previous full-term deliveries, in an effort to avoid missing at-risk cases.

The guidelines also call for ultrasound screening of cervical length during the second trimester, between 18 and 22 weeks of gestation. Women found to have a cervical length of 25 mm or less may be offered progesterone therapy or cervical cerclage to help prolong pregnancy. This screening programme will be introduced in phases.

In terms of treatment, oral nifedipine is now recommended as the preferred option for suppressing preterm labour contractions, replacing intravenous alternatives to improve both safety and convenience. For women at risk of preterm delivery between 24 and 32 weeks of pregnancy, magnesium sulfate is recommended to reduce the risk of brain injury in newborns.

The updated approach comes amid findings that awareness of preterm birth remains limited. A study conducted this year by KKH involving 115 women aged between 21 and 45 found that 45 per cent were unaware of risk factors for preterm birth, 67 per cent did not recognise its symptoms, and 63 per cent were unaware of its potential long-term effects.

Healthcare authorities say the new guidelines are intended to equip clinicians with evidence-based tools to better identify high-risk pregnancies early and intervene effectively, ultimately reducing the incidence and impact of premature birth in Singapore.