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PubMed1993

Possible role of asthma in the risk of preterm labor and delivery.

We assessed the relation between maternal respiratory problems and preterm labor and delivery in a cohort of 3,891 women who delivered a singleton livebirth. Study participants were asked about their medical history in the 12 months before conception; women who reported a history of asthma had a higher risk of preterm labor [relative risk (RR) estimate = 2.33, 95% confidence interval (CI) = 1.03-5.26]. Asthmatic women also had an increased risk of preterm delivery (RR = 1.77, 95% CI = 0.60-5.24). Maternal respiratory problems during pregnancy were also associated with an increased risk of both inhibited preterm labor (RR = 2.14, 95% CI = 1.25-3.66) and preterm delivery (RR = 2.03, 95% CI = 1.08-3.82). Birthweight appeared to be unrelated to maternal history of asthma. Logistic regression models that adjusted for potential confounders did not appreciably alter the results. The adjusted odds ratio (OR) estimate for the odds of preterm labor in asthmatics relative to nonasthmatics is 2.42 (95% CI = 0.90-6.54); the analogous OR estimate for those with respiratory problems during pregnancy is 2.16 (95% CI = 1.14-4.10). The adjusted OR estimate for the odds of preterm delivery in asthmatics is 1.78 (95% CI = 0.53-6.02); for those with respiratory problems during pregnancy, the corresponding estimate is 2.00 (95% CI = 0.92-4.13).

Adult↗

PubMed2003

Recent evidence associated with the condition of preterm prelabour rupture of the membranes.

PURPOSE OF REVIEW: The published literature on preterm prelabour rupture of the membranes is voluminous yet despite advances in obstetric and neonatal care, the problem remains a major cause of perinatal mortality and morbidity. The purpose of this review is to present recent evidence pertaining to the role of inflammatory mediators such as cytokines and the tissue damage and long-term handicap they cause, the molecular biology and physiology of membrane structure, the role of host susceptibility and the genetics of preterm birth and therapeutic options for the management of preterm prelabour rupture, including antibiotics, amnioinfusion and special situations. RECENT FINDINGS: Neonatal morbidity from preterm prelabour rupture of the membranes is mainly related to oligohydramnios and pulmonary hypoplasia. Occupational factors have a significant effect on the occurrence and outcome following rupture. Matrix metalloproteinases control growth and remodelling of the pregnant uterus, placenta and membranes and are linked to a genetic predisposition to preterm birth through gene expression and variation. Transvaginal ultrasound scan, oncofetal fibronectin and the presence of abnormal genital tract flora (bacterial vaginosis) in pregnancy may help in the prediction of preterm birth. SUMMARY: Preterm prelabour membrane rupture remains a management problem, particularly at very early gestations, yet obstetric and neonatal care can make a difference to outcome. While at early gestations the prognosis is poor, it is not hopeless. Careful selection of the recent literature on the subject might interest and inform those faced regularly with the problem, prevent therapeutic nihilism, promote confidence in our ability to make a difference and realise that we are not alone when faced with the therapeutic dilemma that is this condition.

Female↗

PubMed1996

Intraventricular haemorrhage in preterm infants: evidence of suppressed fibrinolysis.

Intraventricular hemorrhage (IVH) in premature infants may be related to the immaturity of the vascular bed in the germinal matrix. We measured six hemostatic parameters whose alterations may represent an additional risk factor for IVH in preterm infants. On postnatal day 1 there were differences between plasminogen activator inhibitor-1 (PAI-1) activity and antigen, of both full-term and preterm infants with and without IVH (P < 0.05). Preterms with IVH were different to both full-terms and preterms without IVH. No difference was observed in plasma concentrations of fibrinogen, plasminogen and von Willebrand factor. Plasma concentrations of antithrombin III were significantly higher in full-term infants than in preterm infants. The difference between the platelet counts of preterm infants with and without IVH was not significant (P > 0.05). Elevation of crosslinked fibrin degradation products (XDP), determined by the SimpliRED D-dimer test, correlated in four out of five premature infants with the diagnosis of IVH by ultrasonography. No elevation of D-dimer XDP was observed in premature infants without IVH (11/12) and full-term infants (6/6). In conclusion, a hypercoagulable state, indicated by a rise in D-dimer XDP, may be initiated by some types of trauma to fragile blood vessels of the preterm infants who develop IVH. This hypercoagulability is further exacerbated by the increased release of PAI-1 leading to suppressed fibrinolysis.

Cerebral Hemorrhage↗

PubMed1986

Prevention of preterm labor and premature rupture of the membranes.

Preterm delivery is currently the leading cause of perinatal morbidity and mortality. PROM is the most common easily identifiable cause of preterm delivery, present in 20-30% of preterm births. The conflicting results of success in prematurity prevention programs obtained by different investigators probably reflect the populations that were studied. Meis and colleagues divided the etiologies of low birth weight into four categories: 1) Low birth weight in infants greater than 37 weeks' gestation, 2) PROM, 3) birth weight caused by medical complications, and 4) idiopathic premature labor (IPL). In patients seen in the county health department clinic (1,529 births), IPL accounted for 25% of birth weights less than 2,500 g. In contrast, patients seen in a large private obstetric practice (1,327 births), IPL was the etiology of low birth weight in 47% of patients. Not surprisingly, a prematurity prevention program has not reduced the rate of low birth weight for the public patients but has resulted in decreases of low birth weight for the private patients. Paramount in the prevention of preterm birth is physician education regarding known risk factors, signs and symptoms of preterm labor, and the role of close follow-up in the patients identified as high risk. Papiernik's success with limitation of physical efforts and work leave, when appropriate, in high-risk patients is laudable and, many feel, should be emulated. Prenatal care must include for each woman education concerning the signs and symptoms of preterm labor and PROM. Individual risk factors must be ascertained and followed with appropriate observation, therapy, and/or modification plans. Finally, the early detection of preterm labor will expedite prompt treatment and so increase chances of postponing delivery.

Female↗

PubMed1998

Has the use of home monitors, fetal fibronectin, and measurement of cervical length helped predict labor and/or prevent preterm delivery in twins?

Home monitoring accurately detects contractions, and thus is useful in predicting preterm labor. Appropriate physician action is necessary to significantly prolong pregnancy even in the presence of evidence of excessive contractions. Despite conflicting studies, the majority of evidence heavily favors the use of monitoring as part of a comprehensive preterm birth prevention program. Indeed, monitoring has greater clinical utility in twin gestations because of the recognized propensity for preterm labor. Fetal fibronectin is one of the most sensitive and specific markers for preterm labor and subsequent early delivery presently available. It appears to be equally effective in multifetal gestations compared with singleton gestations, but intervention trials are needed to substantiate its clinical effectiveness. Cervical status monitoring by ultrasound correlates inversely with preterm labor, but studies in twin gestation are currently lacking. Other markers, such as salivary estriol for preterm labor, have yet to be assessed as predictors of preterm labor among multifetal gestations.

Cervix Uteri↗

PubMedDate not supplied

Monitoring the preterm fetus during labor.

The purpose of this article is to discuss special challenges in monitoring the preterm fetus during labor, review implications of preterm fetal heart rate (FHR) patterns, and highlight appropriate nursing interventions that contribute to the best outcomes for mothers and babies. With the current incidence of preterm birth, monitoring the preterm fetus during labor is a common perinatal nursing responsibility. Most of the published research on this topic was conducted in the 1980s; there has been little attention to FHR monitoring during preterm labor in recent studies. There has been much more accumulated evidence about antepartum testing techniques involving electronic fetal monitoring (EFM) for the preterm fetus in contrast to FHR patterns during labor. Thus, this is an area of opportunity for nursing research. The perinatal nurse has a key role in promoting positive outcomes when caring for women during preterm labor. The condition of the fetus during labor and birth has a significant impact on the likelihood of survival and the odds of developing serious complications of prematurity.

Cardiotocography↗

PubMedDate not supplied

Development of behaviors in preterm infants: relation to sleeping and waking.

BACKGROUND: Although nurse clinicians and researchers use infant behaviors to indicate the responses of preterm infant to stimulation, little is known about how the biological factors of development, sleeping and waking states, infant characteristics, and infant illness severity affect preterm infant behaviors. OBJECTIVE: This study examined the development of eight infant behaviors over the preterm period and determined the relation of these behaviors to sleeping and waking and to infant characteristics and illness severity. METHODS: Seventy-one preterm infants were observed once per week from 7:00 p.m. to 11:00 p.m. from the time they were no longer critical until term or discharge. The occurrence of four sleep-wake states and eight behaviors were recorded every 10 seconds during the observations. RESULTS: Negative facial expressions increased over the preterm period; sighs, startle/jerks, jitters, and the likelihood of having hiccups decreased. Infant characteristics had only minor effects: boys had more negative facial expressions, and longer mechanical ventilation was associated with more sighs and jitters. All behaviors showed state-related differences in frequency. In addition, only startle/jerks and jitters showed the same developmental patterns within each state. CONCLUSIONS: Significant development of infant behaviors occurs over the preterm period but involves changes not only in the absolute percentage of each behavior but also in the percentages within each sleeping and waking state. Thus, preterm infant behaviors cannot be used clinically for assessment without consideration of the state in which they occur.

Activity Cycles↗

PubMed2000

Mechanism of parturition and preterm labor.

UNLABELLED: Preterm birth occurs in 5 to 10 percent of all pregnancies and accounts for 75 percent of neonatal mortality and morbidity, including long-term handicap. Thirty percent of preterm birth may be associated with an underlying infective process, and approximately 50 percent are idiopathic. Preterm birth corresponds to a syndrome with a variety of causes. The factors contributing to preterm birth may vary at different "windows" of gestation. Glucocorticoids seem to have a central role in processes of birth at term and preterm, and alter synthesis and/or activity of key enzymes in prostaglandin synthesis and metabolism as well as increasing corticotropin-releasing hormone output by intrauterine tissues. This new information should facilitate development of improved methods of diagnosis and therapy for patients at risk of preterm labor. TARGET AUDIENCE: Gynecologists and Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to describe potential mechanisms of partition and preterm labor and to list the various substances that can inhibit and promote myometrial contractions.

Adult↗

PubMed2004

Low maternal age and neonatal survival of extremely preterm twins (20-28 weeks of gestation).

OBJECTIVE: We investigated the relationship between low maternal age and neonatal survival among extremely preterm twins. METHODS: This was a retrospective cohort study on live births of extremely preterm twins delivered to teenaged mothers (aged 15-19 years) in the United States within the period 1995 through 1998. Overall neonatal and early and late neonatal mortality in this category was compared with that of a similar group of twins born to young adult mothers (aged 20-29 years). We used the generalized estimating equation framework in computing relative risks after adjusting for intracluster correlations. RESULTS: Analysis involved 2,290 extremely preterm liveborn twins of teenaged mothers and 8,709 born to young adult mothers. Overall, neonatal mortality was 29% higher among the extremely preterm twins born to teenaged mothers (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.04%, 1.59%). The disparity in neonatal survival was chiefly in the early neonatal period (adjusted OR 1.34; 95% CI 1.07%, 1.67%), while late neonatal mortality was comparable (adjusted OR 0.91; 95% CI 0.58%, 1.42%). In addition, twins of teenaged mothers had significantly higher level of mortality, except for the birth weight category of 1,000-1,499 g. CONCLUSION: Low maternal age was found to be associated with elevated risk of neonatal death among extremely preterm twins. The preponderance of deaths among extremely preterm twins of teenaged mothers in the early neonatal period appeared to be responsible for the disparity in survival. This information may be useful for targeted interventions aimed at enhancing survival of extremely preterm twins born to teenagers, as well as for instituting optimal management options in the clinical setting. LEVEL OF EVIDENCE: II-2

Adolescent↗

PubMed2005

Prediction of preterm delivery in the second trimester.

OBJECTIVE: The aim of this study was to estimate the probability of spontaneous delivery at 34 weeks or less according to cervical assessment by transvaginal scan associated with previous obstetric history. METHODS: Ultrasound transvaginal cervical length and presence of funneling were evaluated in 1,958 singleton pregnancies between 21 and 24 weeks of gestation. For the prediction of preterm delivery, the results of cervical assessment were analyzed in association with the previous obstetric history of preterm delivery, spontaneous miscarriage, and curettage. Sensitivity, specificity, and positive and negative predictive values for the various cutoff cervical lengths in the groups with or without previous history of preterm delivery were calculated. Multivariable regression analysis was used to identify the predictive factors for preterm delivery at 34 weeks or less. RESULTS: The incidence of spontaneous delivery at gestational age of 34 weeks or less was 3.4%. The mean cervical length was 30.1 mm (standard deviation 10.1 mm) in the group with previous history of prematurity (n = 180) and 35.8 mm (standard deviation 7.9 mm) in the group without previous history of prematurity (P < .001). The mean cervical length in the group of patients who delivered at or before 34 weeks was 23.8 mm, and for patients who delivered after 34 weeks it was 35.6 mm (P < .001). The mean gestational age at delivery was significantly lower in the group with funneling compared with the group without funneling (33.5 weeks versus 38.8 weeks, P < .001). Logistic regression analysis demonstrated that cervical length, funneling, and history of previous preterm delivery were independent contributors for preterm delivery. CONCLUSION: Ultrasound cervical assessment may be useful in the prediction of preterm delivery, but it should also be considered in association with the obstetric history of prematurity.

Adult↗

PubMed2005

17 hydroxyprogesterone for the prevention of preterm delivery.

The recent publication of 2 large randomized trials of 17 alpha hydroxyprogesterone caproate (17P) and progesterone suppositories, respectively, for the prevention of premature labor have renewed interest in the use of progesterone to prevent preterm birth. The results of these trials have reinforced the positive results of earlier smaller trials of 17P to prevent preterm delivery. A large body of evidence attests to the lack of teratogenic effects of 17P in pregnancy. Although progesterone is known to have many actions beneficial to the maintenance of pregnancy, the exact mode of action of 17P therapy in preventing preterm labor and delivery is not known. Current evidence supports the use of 17P treatment, begun early in the second trimester of gestation and continued weekly until 36 weeks, for women with a history of a previous spontaneous preterm delivery. At present no evidence exists for the use of 17P to prevent preterm delivery in women with multiple gestation, a short uterine cervix, or other high-risk conditions. The use of 17P or other progestins should not be encouraged for these indications outside of randomized trials. At present no evidence exists for the efficacy of any oral progesterone compound in preventing preterm labor. Four trials reporting the use of a progestational drug in patients with symptoms of preterm labor found no efficacy in prolonging pregnancy, and the use of 17P or other progestational drugs as tocolytic therapy should not be encouraged.

17-alpha-Hydroxyprogesterone↗

PubMed2005

Serum C-reactive protein and Chlamydia trachomatis antibodies in preterm delivery.

OBJECTIVE: To assess the association between Chlamydia trachomatis antibodies, antibodies to C trachomatis heat shock proteins 60 and 10, and C-reactive protein (CRP) levels in maternal serum measured by highly sensitive CRP assay during the first trimester and spontaneous preterm delivery before 37 weeks of gestation. METHODS: This was a nested case-control study of 104 spontaneous preterm singleton deliveries (cases) and 402 term singleton deliveries, as controls, of mothers belonging to the population-based Northern Finland 1966 Birth Cohort. Data on 2,309 first deliveries were available from the Finnish Medical Birth Register. Serum C trachomatis and C pneumoniae antibodies were measured by the microimmunofluorescence test and chlamydial heat shock proteins 60 and 10 antibodies by enzyme immunoassay using recombinant proteins as antigens, and highly sensitive CRP levels were quantified with highly sensitive immunoenzymometric assay. RESULTS: Highly sensitive CRP levels were higher and C trachomatis immunoglobulin G levels (pools and individual serotypes) were more often present (thought not nominally significantly in all cases) in the women with preterm compared with term deliveries. Elevated immunoglobulin G levels of C trachomatis antibodies or elevated highly sensitive CRP levels alone, however, did not increase the estimated risk for preterm delivery, but when they were present simultaneously, the estimated risk for preterm delivery was 4-fold (odds ratio 4.3, 95% confidence interval 2.0-9.3). Among the women delivered at or before 34 weeks of gestation, the estimated risk was even more evident (odds ratio 5.6, 95% confidence interval 2.1-14.5). The preterm delivery rate was 26.5% for those with C trachomatis antibodies and 18.8% for those without C trachomatis antibodies. CONCLUSION: The results of the present study suggest that chlamydial infection in the first trimester is associated with preterm delivery. LEVEL OF EVIDENCE: II-2.

Adult↗

PubMed2004

Polymorphisms of the paraoxonase gene and risk of preterm delivery.

BACKGROUND: Human paraoxonase (PON) is an enzyme involved in vasodilation and thrombosis. Disruption of blood blow through the placenta could be part of the pathophysiological mechanism leading to preterm delivery. The purpose of this study was to examine the association between polymorphisms in 2 paraoxonase genes (PON1 and PON2) and preterm delivery. METHODS: We conducted a case-control study using infant-parents triads in Anqing, China. Between July 1999 and June 2001, we enrolled the families of 105 infants born at term and 80 infants born preterm. Genotyping was performed for the polymorphisms of PON1 Q192R, PON2 A148G, and PON2 S311C using standard techniques. We used log-linear modeling to analyze the association of PON1 and PON2 gene polymorphisms with the risk of preterm delivery. RESULTS: In the analysis of children's genotypes, the relative risk was 3.6 (95% confidence interval [CI] = 1.3-11) for PON1 RR compared with PON1 QQ. An association was also seen for PON2 CC compared with PON2 SS (relative risk = 4.6; CI = 1.5-14). There was no association between the mother's PON1 and PON2 genotypes and preterm delivery, and we did not observe an interaction between mothers' and children's genotypes. Analysis of control triads suggests Mendelian transmissions of the variant alleles of PON1 192R, PON2 148G, and PON2 311C. CONCLUSION: Infant PON1 RR and PON2 CC genotypes were associated with preterm delivery in our study population, which suggests a possible role for human paraoxonase variability in the etiology of preterm delivery.

Aryldialkylphosphatase↗

PubMed2005

Risk of spontaneous preterm birth is associated with common proinflammatory cytokine polymorphisms.

BACKGROUND: Preliminary data suggest that common genetic variation in immune response genes can contribute to the risk for spontaneous preterm birth and possibly small-for-gestational age (SGA). METHODS: We investigated the relationship of polymorphisms in 6 cytokine genes associated with inflammation-interleukin (IL)1alpha, IL1beta, IL2, IL6, tumor necrosis factor (TNF), and lymphotoxin alpha (LTA)-with spontaneous preterm and SGA birth in a nested case-control study drawn from a prospective pregnancy cohort. Women were recruited between 24 and 29 weeks' gestation at the Wake County and University of North Carolina, Chapel Hill obstetric clinics between February 1996 and June 2000. We inferred haplotypes using the EM algorithm and the Bayesian method, PHASE. We then compared haplotype frequency distributions and implemented semi-Bayesian hierarchical logistic regression analyses to obtain odds ratio (OR) estimates and 95% confidence intervals (CIs) for each polymorphism. RESULTS: Two haplotypes spanning the TNF/LTA genes were associated with increased risk for spontaneous preterm birth in white subjects (for the AGG haplotype, OR = 1.5 [95% CI=0.8-2.6]; for the GAC haplotype, 1.6 [0.9-2.9]). Additionally, carriers of the GAG haplotype were found to have decreased risk of spontaneous preterm birth (0.6; 0.3-1.0). The TNF(-488)A and LTA(IVS1-82)C variants, constituents of the AGG and GAC haplotypes respectively, were also strongly associated with increased risk of spontaneous preterm birth. CONCLUSIONS: Our results suggest that common genetic variants in proinflammatory cytokine genes could influence the risk for spontaneous preterm birth. Selected TNF/LTA haplotypes were associated with spontaneous preterm birth in both African-American and white subjects. Our data do not support an inflammatory etiology for SGA.

Black or African American↗

PubMed2006

Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care.

OBJECTIVE: This article investigates the effects of antenatal depression and anxiety on spontaneous preterm birth resulting either from preterm labor or preterm premature rupture of membranes. METHODS: We conducted a prospective cohort study of 681 women with singleton pregnancies consecutively recruited between 20 and 28 weeks of gestation in the Obstetrics Department of the French University Hospital of Caen. Most were of European ethnic origin and received early and regular antenatal care. The assessment of gestational age was based on ultrasound examination (occurring before 13 weeks of gestation for 94.9% of the women). Depression and anxiety were assessed using self-administered questionnaires: the Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory. Logistic regression analysis, controlling for sociodemographic factors (e.g., maternal age, occupation) and obstetric factors (e.g., previous preterm birth, cervical or vaginal infection), provided adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Spontaneous preterm birth occurred in 31 women (4.8%). The rate of spontaneous preterm birth was significantly higher among women with high depression scores (9.7%) as opposed to other women (4.0%) even after adjustment for potential confounding factors (adjusted OR = 3.3, 95% CI = 1.2-9.2, p = .020). Anxiety was not significantly associated with the outcome. There were no significant interaction effects between psychological and biomedical factors. CONCLUSIONS: These findings provide evidence that antenatal depression is significantly associated with spontaneous preterm birth in a population of European women receiving early and regular care.

Adolescent↗

PubMed2006

Neonatal infection and long-term neurodevelopmental outcome in the preterm infant.

PURPOSE OF REVIEW: The relationship between infection, the inflammatory response and adverse neurodevelopmental outcome in preterm infants is slowly being elucidated. The developing brain, particularly the periventricular white matter, is vulnerable to cytotoxic and hypoxic/ischemic injury, which places these infants at increased risk for abnormal cognitive and motor functioning. This review summarizes current data evaluating associations between infection and neurodevelopmental outcome in the preterm infant. RECENT FINDINGS: Preterm infants are at risk for intrauterine and postnatal infections. Recent studies have linked infection/inflammation associated with chorioamnionitis, sepsis and necrotizing enterocolitis with adverse neurodevelopmental outcome and impaired growth in preterm infants. Investigators have also shown associations between infection and brain injury, including severe intraventricular hemorrhage and periventricular leukomalacia. Very-low-birth-weight preterm infants are at substantial risk for neonatal infection, with associated morbidity and mortality. It is postulated that exposure of the preterm brain to inflammatory mediators during infectious episodes contributes to brain injury and poor developmental outcome. SUMMARY: Enhanced understanding of the interaction of infection, inflammation and brain injury will be critical to developing strategies to improve neurodevelopmental outcome in preterm infants.

Enterocolitis, Necrotizing↗

PubMed2006

Predicting high-risk preterm birth using artificial neural networks.

A reengineered approach to the early prediction of preterm birth is presented as a complimentary technique to the current procedure of using costly and invasive clinical testing on high-risk maternal populations. Artificial neural networks (ANNs) are employed as a screening tool for preterm birth on a heterogeneous maternal population; risk estimations use obstetrical variables available to physicians before 23 weeks gestation. The objective was to assess if ANNs have a potential use in obstetrical outcome estimations in low-risk maternal populations. The back-propagation feedforward ANN was trained and tested on cases with eight input variables describing the patient's obstetrical history; the output variables were: 1) preterm birth; 2) high-risk preterm birth; and 3) a refined high-risk preterm birth outcome excluding all cases where resuscitation was delivered in the form of free flow oxygen. Artificial training sets were created to increase the distribution of the underrepresented class to 20%. Training on the refined high-risk preterm birth model increased the network's sensitivity to 54.8%, compared to just over 20% for the nonartificially distributed preterm birth model.

Artificial Intelligence↗

PubMed2005

Histologic placental lesions in women with recurrent preterm delivery.

BACKGROUND: The aim of this study was to evaluate whether particular placental histopathology lesions are associated with recurrent preterm birth. METHODS: We analyzed a database of 413 consecutive singleton pregnancies delivered at <32 weeks with past reproductive history available. After the exclusion of nulliparous women, the pregnancies were divided according to the obstetrical history into group 1 (n = 328), women without prior preterm delivery (PTD); group 2 (n = 49), women with one prior preterm childbirth; and group 3 (n = 36), women with > or =2 prior preterm deliveries. Demographic and clinical variables were compared among the three groups by using Kruskal-Wallis test and chi-square test for trend. Finally, the individual placental lesions (i.e. 42 lesions of acute or chronic inflammation, uteroplacental vascular pathology, and intraplacental villous lesions) were correlated with the number of prior preterm deliveries by using regression analysis. A two-tailed P < 0.05 was considered significant. RESULTS: No differences were found among the three groups in demographic or clinical variables. Regression analysis of scored placental lesions corrected for gestational age at delivery showed that the number of prior preterm deliveries was correlated only with chronic marginating choriodeciduitis (correlation coefficient = 0.13; P = 0.01) and acute choriodeciduitis (correlation coefficient = 0.14; P = 0.008). CONCLUSIONS: Among women delivered at <32 weeks, those with prior preterm birth have histologic findings compatible with acute or chronic inflammatory involvement of the uterine cavity, suggesting that a prepregnancy endometrial infection rather than an ascending intrapregnancy pathway may be responsible for some recurrences of PTD.

Adult↗