Epidemiology of early pre-term delivery: Relationship with clinical and histopathological infective parameters

Abstract

In this study, we want to evaluate which are the risk factors involved in early pre-term delivery (PTD). Spontaneous PTD results from two clinical conditions: (1) spontaneous pre-term labour (PTL) leading to PTD (idiopathic) and (2) pre-term premature rupture of membranes (pPROM). This is a multicentric, observational, retrospective, cross-sectional study, which includes 7,631 women admitted in the Obstetric units of Siena, Perugia, Torino, Trieste, Milano, Modena, Ancona, Foggia and Catania. Data were obtained from all patients having delivered spontaneously, pre-term or at term. The present study reveals the involvement of inflammation/infection in pathogenetic mechanisms leading to early PTD in the Italian population. A higher incidence of both clinical and pathological parameters of inflammation/infection - pPROM, genitourinary tract infections, placenta histopathological inflammation, WBC and C-reactive protein (CRP) - in early pre-term delivery in respect to late pre-term delivery and delivery at term, were shown.

Effects of prenatal maternal stress on birth outcomes following tropical cyclone Yasi in Queensland, Australia (2011)

“…Premature births are thought to result from a variety of factors affecting the uterine cervix, fetal membranes, placenta or myometrium resulting in an activation before 37 weeks gestation of the parturition pathway [47]. Factors medically associated with the premature triggering of this pathway are complex and include genetic predisposition, infection, disease, pregnancy complications or stress [48].…”

The Progress of Perinatal Medicine in Italy

“…Training: The standardising of perinatal medicine training processes in all the universities iii. Research: The promotion of multi-center randomized controlled trials, especially for the prevention and treatment of prematurity [8].…”

Compensatory fetal membrane mechanisms between biglycan and decorin in inflammation

“…Substantial clinical data suggest that infection is a significant risk factor for PPROM (Torricelli et al 2013). When exposed to an infectious insult, term human fetal membranes display increased MMP expression (Estrada-Gutierrez et al 2010).…”

“…However, while we know that mutations leading to abnormal processing of biglycan and decorin (Barabas 1966; Quentin et al 1990) as well as infection (Torricelli et al 2013) play a role in the pathogenesis of PPROM, the mechanism by which infection modulates the function of biglycan and decorin and their dependent signaling pathways in the fetal membranes is not known.…”

“…Coupled with studies indicating that biglycan and decorin both play a role in inflammatory cascades (Babelova et al, ; Merline et al, ), these observations suggest that infection may significantly impact the biglycan and decorin‐dependent signaling that modulate fetal membrane mechanical properties. While we know that mutations leading to abnormal processing of biglycan and decorin (Barabas ; Quentin et al, ) as well as infection (Torricelli et al, ) play a role in the pathogenesis of PPROM, the mechanism by which infection modulates the function of biglycan and decorin and their signaling activity in the fetal membrane is not known.…”