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Samenvatting artikelen prematuriteit
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Prematuriteit artikelenhttp://www.sciencedirect.com/science/article/pii/S0140673608600744
1. Epidemiology and causes of preterm birth – Goldenberg
This paper is the first in a three-part series on preterm birth, which is the leading cause of perinatal
morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks’
gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture
of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal
indications. The frequency of preterm births is about 12–13% in the USA and 5–9% in many other
developed countries; however, the rate of preterm birth has increased in many locations,
predominantly because of increasing indicated preterm births and preterm delivery of artificially
conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia
or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and
PPROM—together called spontaneous preterm births—are regarded as a syndrome resulting from
multiple causes, including infection or inflammation, vascular disease, and uterine overdistension
(overstretchen). Risk factors for spontaneous preterm births include a previous preterm birth, black
race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised
cervical-vaginal fetal fibronectin concentration are the strongest predictors of spontaneous preterm
birth.
Preterm births account for 75% of perinatal mortality and more than half the long-term morbidity.
Although most preterm babies survive, they are at increased risk of neurodevelopmental
impairments and respiratory and gastrointestinal complications.
Precursors leading to preterm birth are:
1) Delivery for maternal or fetal indications, in which labour is either induced or the infant is
delivered by prelabour caesarean section.
2) Spontaneous preterm labour with intact membranes
3) Preterm premature rupture of the membranes (PPROM), irrespective of whether delivery is
vaginal or by caesarean section.
Spontaneous preterm birth is most commonly caused by preterm labour in white women, but by
PPROM in black women.
A high number of preterm multiple gestations associated with assisted reproductive technologies is
also an important contributor to the overall increase in preterm births.
PPROM= defined as spontaneous rupture of the membranes at less than 37 weeks’ gestation at least
1 hour before the onset of contractions. The cause of membrane rupture in most cases is unknown,
but asymptomatic intrauterine infection is a frequent precursor.
Risk factors for PPROM are generally similar to those for preterm spontaneous labour with intact
membranes, although infections and tobacco exposure play important parts.
Since the membranes generally form a barrier to ascending infection, a common complication of
PPROM is development of intrauterine infection and preterm labour.
Theories proposed to explain the initiation of term labour are:
1) Progesterone withdrawal
2) Oxytocin initiation
3) Decidual activation
1
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