The preterm parturition syndrome

医学 病态的 怀孕 炎症 胎膜早破 病因学 绒毛膜羊膜炎 疾病 胎儿 生物信息学 免疫学 内科学 生物 遗传学
作者
Roberto Romero,Jimmy Espinoza,Juan Pedro Kusanovic,Francesca Gotsch,Sonia S. Hassan,Offer Erez,Tinnakorn Chaiworapongsa,M. Mazor
出处
期刊:Bjog: An International Journal Of Obstetrics And Gynaecology [Wiley]
卷期号:113 (s3): 17-42 被引量:1343
标识
DOI:10.1111/j.1471-0528.2006.01120.x
摘要

The implicit paradigm that has governed the study and clinical management of preterm labour is that term and preterm parturition are the same processes, except for the gestational age at which they occur. Indeed, both share a common pathway composed of uterine contractility, cervical dilatation and activation of the membranes/decidua. This review explores the concept that while term labour results from physiological activation of the components of the common pathway, preterm labour arises from pathological signalling and activation of one or more components of the common pathway of parturition. The term ‘great obstetrical syndromes’ has been coined to reframe the concept of obstetrical disease. Such syndromes are characterised by: (1) multiple aetiology; (2) long preclinical stage; (3) frequent fetal involvement; (4) clinical manifestations that are often adaptive in nature; and (5) gene–environment interactions that may predispose to the syndromes. This article reviews the evidence indicating that the pathological processes implicated in the preterm parturition syndrome include: (1) intrauterine infection/inflammation; (2) uterine ischaemia; (3) uterine overdistension; (4) abnormal allograft reaction; (5) allergy; (6) cervical insufficiency; and (7) hormonal disorders (progesterone related and corticotrophin‐releasing factor related). The implications of this conceptual framework for the prevention, diagnosis, and treatment of preterm labour are discussed.
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