A Perinatal Pathology View of Preterm Labor

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Clinical Heterogeneity of Prematurity

Clinical risk factors for prematurity identifiable before pregnancy have been shown to include previous preterm delivery, intrapregnancy interval, cervical or uterine structural anomalies, thyroid disease, systemic hypertension, maternal race and age, smoking, and drug misuse. During pregnancy, the development of hypertension with or without preeclampsia, hemorrhage as evidenced by vaginal bleeding, acute-onset kidney or liver disease, polyhydramnios, poor maternal weight gain, fetal anomalies, cervical incompetency, multiple gestation, fetal growth restriction, reproductive tract infection, and premature rupture of the membranes are among the conditions that may indicate preterm delivery. Such cases of indicated prematurity, however, account for only about 20% of all cases of prematurity.

It is difficult to segregate cases of prematurity into discrete categories. Cases with seemingly similar pathophysiologic origins, such as clinically documented acute ascending infection or uteroplacental insufficiency, may present with preterm labor, premature rupture of the membranes, or isolated cervical dilatation, or any combination of the three. It is likely then that models that include multiple clinical indicators, psychosocial factors, and pathologic correlates will be most successful in determining risk of prematurity.


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