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The preterm parturition syndrome.

R Romero1, J Espinoza, J P Kusanovic

  • 1Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD 20892, USA. awarfiel@med.wayne.edu

BJOG : an International Journal of Obstetrics and Gynaecology
|January 9, 2007
PubMed
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Preterm labor, unlike term labor, stems from pathological signaling, not physiological processes. This review reframes preterm birth as a "great obstetrical syndrome" with multiple causes and implications for treatment.

Area of Science:

  • Obstetrics and Gynecology
  • Reproductive Medicine
  • Fetal Medicine

Background:

  • Current understanding views term and preterm labor as similar processes differing only in gestational age.
  • Both processes share a common pathway involving uterine contractility, cervical dilation, and membrane/decidual activation.

Purpose of the Study:

  • To challenge the paradigm that term and preterm labor share identical pathways.
  • To propose that preterm labor results from pathological signaling activating common parturition pathways.
  • To introduce the concept of "great obstetrical syndromes" to reframe obstetrical diseases, including preterm labor.

Main Methods:

  • Literature review of evidence for pathological processes in preterm parturition.
  • Analysis of characteristics defining "great obstetrical syndromes" and their applicability to preterm labor.

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  • Discussion of implications for clinical management based on a new conceptual framework.

    • Main Results:

    • Preterm labor is proposed to arise from pathological signaling, distinct from the physiological activation in term labor.
    • Pathological processes implicated include intrauterine infection/inflammation, uterine ischemia, overdistension, abnormal allograft reactions, allergy, cervical insufficiency, and hormonal disorders.
    • Preterm parturition syndrome shares characteristics with "great obstetrical syndromes": multiple etiologies, long preclinical stages, fetal involvement, adaptive clinical manifestations, and gene-environment interactions.

    Conclusions:

    • Reframing preterm labor as a pathological "great obstetrical syndrome" offers a new perspective on its diverse etiologies.
    • Understanding these pathological pathways is crucial for developing improved prevention, diagnosis, and treatment strategies for preterm birth.
    • This conceptual shift necessitates a re-evaluation of clinical management approaches to preterm labor.