Di Renzo Gian Carlo, Roura Lluis Cabero
Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.
J Perinat Med. 2006;34(5):359-66. doi: 10.1515/JPM.2006.073.
Preterm birth is defined as delivery at <37 completed weeks of pregnancy (World Health Organization). Spontaneous preterm birth (SPB) includes preterm labor, preterm spontaneous rupture of membranes, preterm premature rupture of membranes (PPROM) and cervical weakness; it does not include indicated preterm delivery for maternal or fetal conditions. Early SPB (<32 weeks' gestation) is associated with an increased higher perinatal mortality rate, inversely proportional to gestational age. The pathophysiologic events that trigger SPB are largely unknown but include decidual hemorrhage (abruption), mechanical factors (uterine overdistention or cervical incompetence), and hormonal changes (perhaps mediated by fetal or maternal stress). In addition, several cervicovaginal infections have been associated with preterm labor. SPB is also the leading cause of long-term morbidity, including neurodevelopmental handicap, cerebral palsy, seizure disorders, blindness, deafness and non-neurological disorders, such as bronchopulmonary dysplasia and retinopathy of prematurity. Delaying delivery may reduce the rate of long-term morbidity by facilitating the maturation of developing organs and systems. The benefits of administration of antepartum glucocorticosteroids to reduce the incidence and severity of respiratory distress syndrome may be exploited by delay. Delay may also permit transfer of the fetus in utero to a center with neonatal intensive care unit facilities. There is considerable variation in the way that spontaneous preterm labor (SPTL) is diagnosed, managed and treated internationally. The development of clinical guidelines requires an evidence-based approach to improve outcome and allow more efficient use of resources. With recent advances in our understanding of the etiology and mechanisms of SPTL and the availability of safer, more specific tocolytics, it was felt that guidelines should be developed to achieve, if possible, an European consensus in patient diagnosis, management and treatment.
早产的定义为妊娠满37周前分娩（世界卫生组织）。自发性早产（SPB）包括早产临产、早产胎膜自破、未足月胎膜早破（PPROM）和宫颈机能不全；不包括因母体或胎儿状况而进行的引产。早期SPB（妊娠<32周）与围产儿死亡率升高相关，且与孕周成反比。引发SPB的病理生理事件大多未知，但包括蜕膜出血（胎盘早剥）、机械因素（子宫过度扩张或宫颈机能不全）以及激素变化（可能由胎儿或母体应激介导）。此外，几种宫颈阴道感染与早产临产有关。SPB也是长期发病的主要原因，包括神经发育障碍、脑瘫、癫痫症、失明、失聪以及非神经系统疾病，如支气管肺发育不良和早产儿视网膜病变。延迟分娩可通过促进发育中的器官和系统成熟来降低长期发病率。延迟分娩可利用产前给予糖皮质激素来降低呼吸窘迫综合征的发生率和严重程度的益处。延迟分娩还可使胎儿在子宫内转运至设有新生儿重症监护病房设施的中心。在国际上，自发性早产临产（SPTL）的诊断、管理和治疗方式存在很大差异。制定临床指南需要采用循证方法来改善结局并更有效地利用资源。随着我们对SPTL病因和机制的认识取得最新进展，以及更安全、更具特异性的宫缩抑制剂的出现，人们认为应制定指南，尽可能在患者诊断、管理和治疗方面达成欧洲共识。
