Andrews W W, Goldenberg R L, Hauth J C
Department of Obstetrics and Gynecology, University of Alabama at Birmingham 35233-7333, USA.
Infect Agents Dis. 1995 Dec;4(4):196-211.
Preterm birth complicates 8-10% of all pregnancies in the United States and is the leading cause of infant morbidity and mortality. Neonatal morbidity and mortality is concentrated among very low-birthweight and extremely premature infants, particularly those delivered prior to 30 weeks' gestational age. In addition to the contribution of preterm birth to neonatal morbidity and mortality, the economic costs associated with this pregnancy complication are staggering. Efforts to reduce the preterm birth rate have been largely focused on prevention and early intervention with treatment for preterm labor. Mixed results regarding the success of prematurity prevention programs have been reported, and controversy continues to surround the efficacy of tocolytic therapy in the treatment of preterm labor. Although neonatal survival for infants born at early gestational ages has steadily improved in recent years, survival of infants delivered prior to 24 weeks' gestation remains very poor. Additionally, despite this decline in neonatal mortality, the United States still lags behind most industrialized nations in infant mortality, and no change in the rate of low birthweight has occurred in recent decades. Multiple lines of evidence support a role for infection as an etiologic factor in preterm labor. Although this association has been well known for many years, a wealth of new data is emerging, linking subclinical genital tract infection with spontaneous preterm birth, particularly among pregnancies that result in birth prior to 30 weeks' gestational age as a result of spontaneous preterm labor or preterm, premature rupture of membranes. Conversely, preterm birth that occurs closer to term is less likely to be associated with genital tract infection. Improved understanding of the link between genital tract infection and preterm birth now provides an exciting potential for the development of sensitive new markers to identify women at risk and effective interventions to prevent preterm birth. A review and comment on this growing literature is provided.
在美国，早产使8%至10%的妊娠复杂化，是婴儿发病和死亡的主要原因。新生儿发病和死亡主要集中在极低出生体重儿和极早产儿中，尤其是那些孕龄小于30周就出生的婴儿。除了早产对新生儿发病和死亡的影响外，这种妊娠并发症带来的经济成本也高得惊人。降低早产率的努力主要集中在预防和对早产进行早期干预治疗上。关于早产预防项目的成功结果不一，并且对于宫缩抑制剂治疗早产的疗效仍存在争议。尽管近年来孕龄较小的婴儿的新生儿存活率稳步提高，但孕龄小于24周出生的婴儿的存活率仍然很低。此外，尽管新生儿死亡率有所下降，但美国在婴儿死亡率方面仍落后于大多数工业化国家，并且近几十年来低出生体重率没有变化。多条证据支持感染是早产的一个病因。尽管这种关联已为人所知多年，但大量新数据不断涌现，将亚临床生殖道感染与自发性早产联系起来，特别是在因自发性早产或胎膜早破导致孕龄小于30周出生的妊娠中。相反，接近足月时发生的早产与生殖道感染的关联较小。对生殖道感染与早产之间联系的进一步了解为开发敏感的新标志物以识别高危女性以及预防早产的有效干预措施提供了令人兴奋的潜力。本文对这一不断增多的文献进行了综述和评论。
