Department of Obstetrics and Gynecology, Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.
Department of Obstetrics and Gynecology, Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.
Best Pract Res Clin Obstet Gynaecol. 2018 Oct;52:13-22. doi: 10.1016/j.bpobgyn.2018.01.022. Epub 2018 Feb 16.
The time of birth is a critical determinant of perinatal and long-term outcomes. Preterm birth is still the first cause of infant mortality and morbidity; unfortunately, rates of preterm birth remain high in both high- and low-resource countries, ranging from 5% to 18%. Preterm parturition is a syndrome, which can be induced by various factors such as infection, cervical pathology, uterine overdistension, progesterone deficiency, vascular alterations (utero-placental ischemia, decidual hemorrhage), maternal and fetal stress, allograft reaction, allergic phenomena, and probably other several unknown factors. These various etiologies can lead to the pathological activation of a common pathway of decidua/fetal membranes, which causes uterine contractility, cervical ripening, and rupture of membranes. Moreover, the mechanisms responsible for these processes have been identified, which involve receptors, chemokines, and inflammatory cytokines. It is very important to understand the cellular and biochemical pathways responsible for preterm labor to identify, treat, and prevent negative outcome in a timely manner. Clinicians and researchers play a key role in improving biochemical knowledge on preterm delivery, identifying risk factors, and shaping interventions that can address this complex syndrome.
分娩时间是围产期和长期结局的关键决定因素。早产仍然是婴儿死亡和发病的首要原因；不幸的是，早产率在高资源和低资源国家都居高不下，范围从 5%到 18%。早产分娩是一种综合征，可以由感染、宫颈病变、子宫过度扩张、孕酮缺乏、血管改变（胎盘缺血、蜕膜出血）、母体和胎儿应激、同种异体反应、过敏现象以及可能的其他几个未知因素等多种因素引起。这些不同的病因可能导致蜕膜/胎膜的共同通路病理性激活，从而引起子宫收缩、宫颈成熟和胎膜破裂。此外，已经确定了这些过程的负责机制，其中涉及受体、趋化因子和炎症细胞因子。了解导致早产的细胞和生化途径对于及时识别、治疗和预防不良后果非常重要。临床医生和研究人员在提高早产的生化知识、确定危险因素以及制定可以解决这种复杂综合征的干预措施方面发挥着关键作用。
