The preterm parturition syndrome

The implicit paradigm that has governed file Study and clinical management of preterm labour is that term and preterm parturition arc 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 front physiological activation of the components of the common pathway, preterm labour crises 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 arc 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 arc discussed.