Elsevier

Clinics in Perinatology

Volume 32, Issue 3, September 2005, Pages 571-600
Clinics in Perinatology

Preterm Labor, Preterm Premature Rupture of Membranes, and Chorioamnionitis

https://doi.org/10.1016/j.clp.2005.05.001Get rights and content

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Etiology of preterm birth

Preterm birth is related to physician-initiated birth (indicated preterm birth) or spontaneous preterm birth. Indicated preterm births account for approximately 30% of preterm births. Indicated preterm delivery may result from maternal or fetal risks perceived to be greater than the neonatal risks of preterm birth. The most frequent reasons for indicated preterm birth are pre-eclampsia (40%), fetal distress (30%), intrauterine growth retardation (10%), abruption placenta or placenta previa

The problem of preterm birth

Preterm birth is one of the most common perinatal complications. Despite the enormous amount of research, medical intervention, and money, the incidence in the United States rose by 12% in the 11 years between 1992 and 2002 (Fig. 2) [24]. Approximately 12% of viable pregnancies deliver at less than 37 weeks; and, the incidence of the most vulnerable population (birth at less than 28 weeks) is about 1%. Three major factors have contributed to the rise in the preterm delivery rate: (1) dramatic

Preconceptual care

The gynecologist can play an important role in the prevention of infection-related preterm birth in screening for high-risk sexual behavior, the identification and treatment of asymptomatic sexually transmitted infections (STI), and raising the patient's consciousness of the risks of genital tract infections and preterm birth. In the patient who has had a preterm birth associated with idiopathic preterm labor, PPROM, or idiopathic mid-trimester loss, the gynecologist provides anticipatory

Background

Clinical infection of the intra-amniotic space, IAI, is an indication for immediate antibiotic treatment and delivery. The fetus and the mother are relatively unprotected from the evolving infection; maternal immune systems cannot completely penetrate to the fetus and the fetal immune system is immature, especially in preterm infants. Although infection initially stimulates the uterus to reject the infection (ie, labor), the concentration of cytokines or endotoxins reaches a point at which

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    • Management of clinical chorioamnionitis: an evidence-based approach

      2020, American Journal of Obstetrics and Gynecology
      Citation Excerpt :

      Evidence regarding the association between clinical chorioamnionitis and the risk of cerebral palsy and long-term adverse neurodevelopmental outcomes is conflicting: some studies reported a positive association,20,30–35 whereas others did not.36–40 Clinical chorioamnionitis has been traditionally diagnosed by the presence of maternal fever (temperature of ≥37.8°C or ≥38.0°C) plus 2 or more of the 5 following clinical signs: maternal tachycardia (heart rate of >100 beats per minute), fetal tachycardia (heart rate of >160 beats per minute), uterine tenderness, purulent or foul-smelling amniotic fluid or vaginal discharge, and maternal leukocytosis (white blood cell count of >15,000/mm3).41–43 The diagnostic accuracy of these criteria to identify patients with proven intraamniotic infection is approximately 50%.44

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