Goepfert A R, Goldenberg R L
Department of Obstetrics and Gynecology, University of Alabama at Birmingham 35294-7333, USA.
Curr Opin Obstet Gynecol. 1996 Dec;8(6):417-27.
Preterm birth is the leading cause of perinatal morbidity and mortality. A poor understanding of the underlying pathophysiology of spontaneous preterm labor and preterm premature rupture of membranes has limited our ability to identify those women at highest risk for spontaneous preterm birth. There is increasing evidence that inflammation of the upper genital tract may play a major role in the pathogenesis of preterm labor and preterm premature rupture of membranes. Newer markers of infection and inflammation (e.g. bacterial vaginosis, fetal fibronectin, interleukin-6) may make earlier diagnosis possible and may direct potential therapeutic interventions. A better understanding and more accurate diagnosis of well known risk factors (e.g. cervical dilatation) may also improve treatment options. Additionally, combinations of older risk factors and newer, more sensitive diagnostic methods may greatly increase our ability to predict preterm birth and to identify women who might benefit most from directed intervention strategies.
早产是围产期发病和死亡的主要原因。对自发性早产和胎膜早破潜在病理生理学的认识不足，限制了我们识别那些自发性早产风险最高的女性的能力。越来越多的证据表明，上生殖道炎症可能在早产和胎膜早破的发病机制中起主要作用。感染和炎症的新标志物（如细菌性阴道病、胎儿纤连蛋白、白细胞介素-6）可能使早期诊断成为可能，并可指导潜在的治疗干预措施。对已知风险因素（如宫颈扩张）有更好的理解和更准确的诊断，也可能改善治疗选择。此外，将旧的风险因素与更新的、更敏感的诊断方法相结合，可能会大大提高我们预测早产的能力，并识别出可能从定向干预策略中获益最大的女性。
