Prediction of prematurity.

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.