The August 15, 2014 issue of the prestigious journal Science features a major article about the most important problem in obstetrics: preterm labor. The article, "Preterm Labor: One Syndrome, Many Causes," delivers a powerful message: preterm birth is not one condition, but many, and provides a framework for meeting this challenge. "There are 15 million preterm babies born annually, and the condition affects 5 percent to 15 percent of all pregnancies, with the highest rates in North America and Africa. Prematurity is the leading cause of infant death up to age 1and the second-leading cause of childhood death before the age of 5," said Roberto Romero, M.D., D.Med.Sci., chief of the Perinatology Research Branch (PRB) of the Eunice Kennedy Shriver National Institute of Child Health and Human Development located at Wayne State University (WSU) and the Detroit Medical Center (DMC). "We have made progress by identifying the causes of premature labor, and now we propose that it is possible to reframe the problem and make it tractable." A common belief is that preterm labor is merely labor that starts too soon. This perception derives from the fact that labor, whether term or preterm, has the same features – increased uterine contractility, opening of the cervix, and rupture of the membranes. "However," Dr. Romero said, "the fundamental difference is that normal labor at term occurs when the uterus and placenta cannot continue to support the growth of the fetus within the womb. In contrast, preterm labor results from several disease states." Dr. Romero considers premature labor a syndrome – a collection of syndromes and signs – caused by multiple disease processes. A typical example of these disease processes is a "silent" intra-amniotic infection.
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