The relatively small retrospective observational study by Fox et al is an example of diagnosis sans therapy that is prevalent in obstetric literature. A clinician’s take-home message from this study is to tell 19 patients that they may deliver <34 weeks’ gestation, 12 of whom will not, and 3 of whom will deliver <28 weeks’ gestation. This study does not address the clinical utility of its findings. While the interventional studies referenced by the authors, along with a large body of other interventional studies on preterm labor in monofetal and multifetal pregnancies, have used gestational age at delivery as a surrogate indication of efficacy, none has shown long-term improved neonatal outcome.

Premature birth is a common and frustrating problem with no effective intervention in sight. The editors should consider encouraging the investigators of preterm delivery to go beyond screening and focus on novel treatments with neonatal outcome and cost of care as the primary outcomes.