Universidad de Los Andes, Department of Obstetrics & Gynaecology and Laboratory of Reproductive Biology, Faculty of Medicine , Santiago , Chile.
Expert Opin Investig Drugs. 2014 Jun;23(6):759-71. doi: 10.1517/13543784.2014.905541. Epub 2014 Apr 9.
In developed countries, preterm birth is the major cause of perinatal morbidity, mortality and the most important public health problem in the obstetric field. In the past decades, an increasing trend has been observed regardless of the great efforts focussed on the improvement of our understanding of the physiopathological mechanisms behind preterm labour (PTL) and the improvement in the use of tocolytic drugs.
In this review, the authors focus on some points of the physiopathology of labour in order to understand the rationality behind the different management approaches developed for the PTL syndrome.
There is a need to develop new tools for the treatment of patients with PTL. Research focussed on improving tocolysis, the physiology of labour and pathological processes involved in PTL would afford new approaches for the treatment of PTL, allowing clinicians to provide integrative solutions for this multifactorial disease. Recently, the prophylactic use of progesterone pessary and cerclage in women with high risk of premature labour has been reported to reduce the incidence of premature births and improve neonatal outcomes. These results highlight the importance of prediction models in order to establish preventative strategies early in pregnancy.
在发达国家，早产是围产期发病率、死亡率的主要原因，也是产科领域最重要的公共卫生问题。尽管我们致力于深入了解早产（PTL）的生理病理机制，并改进宫缩抑制剂的使用，但在过去几十年中，早产的发生率仍呈上升趋势。
在这篇综述中，作者关注分娩生理的一些要点，以了解针对 PTL 综合征制定的不同管理方法背后的合理性。
需要开发新的工具来治疗 PTL 患者。专注于改善宫缩抑制剂、分娩生理学以及 PTL 相关病理过程的研究将为 PTL 的治疗提供新方法，使临床医生能够为这种多因素疾病提供综合解决方案。最近，有研究报道，在有早产高风险的妇女中预防性使用孕酮阴道栓剂和宫颈环扎术可降低早产发生率并改善新生儿结局。这些结果强调了预测模型的重要性，以便在妊娠早期确定预防策略。
