A Perinatal Pathology View of Preterm Labor

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Case Study 1

In 1990, the patient was a 31-year-old primipara who presented at 31 weeks with spontaneous membrane rupture. Her pregnancy had been entirely uncomplicated up to that point. Prenatal care had begun at 5 weeks of pregnancy. Her routine prenatal laboratory results were unremarkable, and her medical history placed her at no appreciable risk of complications. Because of the lack of fetal heart rate variability, she was delivered of an appropriately grown male infant who was admitted to the neonatal intensive care unit for respiratory distress. The child showed an initial low-normal white blood cell count with left shift and was placed on prophylactic antibiotics. The placenta was diagnosed as "no pathology." The child did well and was discharged without additional complications.

Seven years later, the patient became pregnant with a different partner and presented at 18 weeks with spontaneous membrane rupture. It was decided not to attempt to prolong the pregnancy because of the advanced cervical dilatation and effacement and the young gestational age. A nonviable female was delivered within 6 hours of presentation. Postpartum work-up revealed a normal hysterosalpingogram, unremarkable cervix, and a negative diethylstilbestrol (DES) exposure history. The placental diagnosis was "severe chorioamnionitis."

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