Goldenberg Robert L, Culhane Jennifer F, Iams Jay D, Romero Roberto
Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19102, USA.
Lancet. 2008 Jan 5;371(9606):75-84. doi: 10.1016/S0140-6736(08)60074-4.
This paper is the first in a three-part series on preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks' gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal indications. The frequency of preterm births is about 12-13% in the USA and 5-9% in many other developed countries; however, the rate of preterm birth has increased in many locations, predominantly because of increasing indicated preterm births and preterm delivery of artificially conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and PPROM-together called spontaneous preterm births-are regarded as a syndrome resulting from multiple causes, including infection or inflammation, vascular disease, and uterine overdistension. Risk factors for spontaneous preterm births include a previous preterm birth, black race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised cervical-vaginal fetal fibronectin concentration are the strongest predictors of spontaneous preterm birth.
本文是关于早产的系列文章的第一篇，该系列共三篇。早产是发达国家围产期发病和死亡的主要原因。婴儿在以下情况后于孕龄小于37周时早产：（1）胎膜完整的自然分娩，（2）胎膜早破（PPROM），以及（3）因母体或胎儿指征进行引产或剖宫产。美国早产的发生率约为12% - 13%，许多其他发达国家为5% - 9%；然而，许多地区的早产率有所上升，主要是因为医源性早产增加以及人工受孕多胎妊娠的早产。医源性早产的常见原因包括子痫前期或子痫以及胎儿生长受限。自然早产和胎膜早破后的分娩——统称为自然早产——被视为由多种原因导致的一种综合征，这些原因包括感染或炎症、血管疾病以及子宫过度扩张。自然早产的风险因素包括既往早产史、黑人种族、牙周病以及孕妇低体重指数。宫颈长度缩短和宫颈 - 阴道胎儿纤连蛋白浓度升高是自然早产最强的预测指标。
