Premium
Classification and heterogeneity of preterm birth
Author(s) -
Moutquin JeanMarie
Publication year - 2003
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1046/j.1471-0528.2003.00021.x
Subject(s) - medicine , obstetrics , premature birth , gestational age , preterm labour , premature rupture of membranes , pregnancy , pediatrics , population , gestation , environmental health , biology , genetics
Three main conditions explain preterm birth: medically indicated (iatrogenic) preterm birth (25%; 18.7–35.2%), preterm premature rupture of membranes (PPROM) (25%; 7.1–51.2%) and spontaneous (idiopathic) preterm birth (50%; 23.2–64.1%). The majority of multiple pregnancies (10% of all preterm births) are delivered preterm (50% for medical reasons). Although medical indications relate more to feto‐maternal conditions, PPROM to infections and idiopathic preterm birth to lifestyle, these risk factors are identified in any category, emphasising that preterm birth has a multifactorial origin. Still, several incidences of preterm birth are not completely explained with a plausible cause for PPROM or spontaneous preterm labour suggesting that other causes have yet to be identified. In addition, preterm birth is associated with unrecognised severe congenital anomalies. Variability within the main categories may be explained by the studied population, ethnic group, social class and preventive interventions towards reducing spontaneous preterm birth where the proportion of medically‐indicated preterm birth is increased. Despite being retrospective a classification according to gestational age at birth is important for neonatal prognosis. Preterm birth is stratified into mild preterm (32–36 weeks), very preterm (28–31 weeks) and extremely preterm (<28 weeks) with increasing neonatal mortality and morbidity. Recent studies suggested that infection was mostly responsible for extreme preterm birth, while stress and lifestyle accounted for mild preterm birth, and a mixture of both conditions contributed to very preterm birth.