Prematurity is the single greatest cause of morbidity and mortality in obstetrics. Families, health care services, and education systems experience the impact of prematurity for the lifetime of the preterm-born child. Health care providers have tried to lower the preterm birth rate with prevention both before and during pregnancy and intervention for symptomatic women. The inability of the health care system to significantly decrease the incidence of preterm birth continues to be a challenge. To further complicate the situation, new data shows that infants born between 34 and 37 weeks' gestation who were thought to have minimal long-term effects of preterm birth may be more at risk than previously appreciated. This article reviews evidence-based risk identification, prevention, and management of women experiencing preterm labor and birth.