42. Pathogenesis and Prediction of Preterm Delivery

  1. John T. Queenan MD1,
  2. Catherine Y. Spong MD2 and
  3. Charles J. Lockwood MD3
  1. Catalin S. Buhimschi MD and
  2. Charles J. Lockwood MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch42

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Buhimschi, C. S. and Lockwood, C. J. (2012) Pathogenesis and Prediction of Preterm Delivery, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch42

Editor Information

  1. 1

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 2

    Bethesda, MD, USA

  3. 3

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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Keywords:

  • preterm delivery, pathogenesis and prediction;
  • PTD, birth before 37 completed weeks' gestation;
  • spontaneous preterm delivery pathogenesis;
  • periconceptional maternal stress, spontaneous PTD;
  • decidual-amnion-chorion inflammation;
  • systemic inflammation, and pneumonia, sepsis, acute cholecystitis;
  • abruption-associated preterm delivery;
  • mechanical stretching of uterus;
  • pathway-specific markers, biomarkers of maternal-fetal stress;
  • genomics and proteomics, in assessment of multiple markers

Summary

Preterm delivery is defined as a birth before 37 weeks' gestation. The percentage of births occurring preterm in the US has recently declined after many years of sustained increases, and was 12.3% in 2008. The decline in preterm births for 2007–2008 was mostly among infants born at 34–36 weeks (late preterm). Specifically, the rate of prematurity for this category decreased from 9.14% in 2006 to 8.77% in 2008. The percentage of infants born at less than 34 weeks also dropped, albeit more modestly, from 3.63% to 3.56%. Declines were registered for almost all age, race, and ethnic categories. Compared to 2007, in 2008 there was a decrease in preterm birth of 4% for non-Hispanic white (11.5% to 11.1%), 6% for non-Hispanic black (18.3% to 17.5%) and 2% for Hispanic infants (12.3% to 12.1%). Unfortunately, the percentage of infants delivered at very low birthweight (less than 1500 g) has declined minimally for 2007–2008, from 1.48% to 1.46%, respectively. The medical relevance of this observation is that it is these newborns who are at the highest risk of early death or disability. Moreover, the overall rate of prematurity continues to represent a relative increase of nearly 20% from 1990 levels. For the last two decades much of the increase in prematurity has been attributed to the epidemic of multifetal gestations and to generally later PTDs deemed necessary due to deteriorating maternal or fetal health.