McElrath T F, Hecht J L, Dammann O, Boggess K, Onderdonk A, Markenson G, Harper M, Delpapa E, Allred E N, Leviton A
Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Am J Epidemiol. 2008 Nov 1;168(9):980-9. doi: 10.1093/aje/kwn202. Epub 2008 Aug 27.
Epidemiologists have grouped the multiple disorders that lead to preterm delivery before the 28th week of gestation in a variety of ways. The authors sought to identify characteristics that would help guide how to classify disorders that lead to such preterm delivery. They enrolled 1,006 women who delivered a liveborn singleton infant of less than 28 weeks' gestation at 14 centers in the United States between 2002 and 2004. Each delivery was classified by presentation: preterm labor (40%), prelabor premature rupture of membranes (23%), preeclampsia (18%), placental abruption (11%), cervical incompetence (5%), and fetal indication/intrauterine growth restriction (3%). Using factor analysis (eigenvalue = 1.73) to compare characteristics identified by standardized interview, chart review, placental histology, and placental microbiology among the presentation groups, the authors found 2 broad patterns. One pattern, characterized by histologic chorioamnionitis and placental microbe recovery, was associated with preterm labor, prelabor premature rupture of membranes, placental abruption, and cervical insufficiency. The other, characterized by a paucity of organisms and inflammation but the presence of histologic features of dysfunctional placentation, was associated with preeclampsia and fetal indication/intrauterine growth restriction. Disorders leading to preterm delivery may be separated into two groups: those associated with intrauterine inflammation and those associated with aberrations of placentation.
流行病学家已经用多种方式对导致妊娠28周前早产的多种疾病进行了分类。作者试图确定有助于指导如何对导致此类早产的疾病进行分类的特征。他们招募了1006名在2002年至2004年间于美国14个中心分娩出孕周小于28周的单胎活产婴儿的女性。每次分娩都根据临床表现进行分类：早产（40%）、临产前胎膜早破（23%）、子痫前期（18%）、胎盘早剥（11%）、宫颈机能不全（5%）以及胎儿指征/胎儿生长受限（3%）。通过因子分析（特征值 = 1.73）来比较各临床表现组中通过标准化访谈、病历审查、胎盘组织学和胎盘微生物学所确定的特征，作者发现了两种主要模式。一种模式以组织学绒毛膜羊膜炎和胎盘微生物检出为特征，与早产、临产前胎膜早破、胎盘早剥和宫颈机能不全相关。另一种模式以微生物和炎症较少但存在胎盘功能异常的组织学特征为特征，与子痫前期和胎儿指征/胎儿生长受限相关。导致早产的疾病可能分为两组：与宫内炎症相关的疾病和与胎盘异常相关的疾病。
