Preterm labor and delivery are among the most challenging obstetric complications encountered by the family physician. In the United States, preterm delivery affects approximately one in 10 births and is the cause of at least 75 percent of neonatal deaths, excluding those related to congenital malformations. Although the cause of preterm labor is unknown, family physicians who provide obstetric care should familiarize themselves and their patients with the predisposing risk factors. Preconception counseling should emphasize family planning, nutrition, "safe sex techniques", treatment of sexually transmitted diseases, and avoidance of cigarettes, alcohol, abusive drugs and harmful work conditions. The rate of fetal morbidity can be reduced with the early and accurate diagnosis of preterm labor, intervention to delay preterm delivery, administration of corticosteroids and provision of neonatal care. Research into biochemical markers such as fetal fibronectin, possible infectious etiologies such as bacterial vaginosis, and the use of more selective tocolytic therapy offers hope that new therapeutic approaches may increase rates of fetal survival.