Cellular and biochemical mechanisms, risk factors and management of preterm birth: state of the art.
Preterm birth (PTB) is usually defined as a delivery before 37 completed weeks or 259 days of gestation. World Health Organization estimates a worldwide incidence of PTB of 9.6%. Infants born preterm are at higher risks than infants born at term for mortality, and acute and chronic morbidity. Major causes of PTB are the following: spontaneous preterm labor with intact membranes (50%), labor induction or caesarean delivery for maternal or fetal indications (30%), and preterm premature rupture of membranes or PPROM (20%). The aim of this review is to analyze this medical condition, focusing on cellular and biochemical mechanisms, maternal risk factors and role of inflammation and infections in preterm premature rupture of membranes (PPROM) and PTB. Moreover we will discuss about the proper therapeutic strategies for its management. Although different methods have been introduced to predict the advent of preterm labour in asymptomatic women, possibilities for real primary prevention are rare. An early estimation of potential risk factors is pivotal in the secondary prevention of PTB. Finally most efforts so far have been tertiary interventions. These measures have reduced perinatal morbidity and mortality. Advances in primary and secondary care will be needed to prevent prematurity-related illness in infants and children.
Department of Medical Surgical Specialties Gynecology and Obstetrics Section, University of Catania, Catania, Italy - vitalesalvatore@hotmail.com.
S G
SG
Vitale
I
I
Marilli
A M
AM
Rapisarda
D
D
Rossetti
G
G
Belluomo
V
V
Iapichino
F
F
Stancanelli
A
A
Cianci
D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods