The preterm birth syndrome: issues to consider in creating a classification system

Goldenberg, Robert L.; Gravett, Michael G.; Iams, Jay D.; Papageorghiou, Aris T.; Waller, Sarah A.; Kramer, Michael S.; Culhane, Jennifer F.; Barros, Fernando C.; Conde‐Agudelo, A.; Bhutta, Zulfiqar Ahmed; Knight, Hannah; Villar, José

doi:10.1016/j.ajog.2011.10.865

Cited by 197 publications

(174 citation statements)

References 39 publications

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“…9 We believe that our proposed phenotype definitions will allow clinicians and researchers to more accurately group women by possible underlying PTB etiology, which may facilitate future identification of group-specific interventions. 8 Our study has several strengths. All women were identified and enrolled prospectively with standardized data collection.…”

Section: Commentmentioning

confidence: 96%

“…As part of the 2009 Global Alliance to Prevent Prematurity and Stillbirth Conference, several groups of investigators have proposed a new method for classifying PTB. [7][8][9] The classifies both induced and spontaneous PTB, describes factors that arise from fetal and maternal conditions, and distinguishes between preterm delivery following 'idiopathic' preterm labor vs. PPROM. Some patterns have been identified using this approach.…”

Section: Commentmentioning

confidence: 99%

“…[4][5][6] A multitude of poorly understood mechanisms are necessary for pregnancy maintenance and the normal transition to labor. 7,8 The initiation of preterm parturition also remains poorly understood, but multiple potential causes and triggers are thought to result in the final common pathway of PTB. The phenotype of PTB refers to the biochemical and physical characteristics of the mother, fetus, and/or placenta that lead to, and/or are present at the time of, delivery.…”

Section: Introductionmentioning

confidence: 99%

“…maternal infections, short cervical length, polyhydramnios), delivery clinical presentation (e.g., contractions, bleeding, advanced cervical dilation), and relevant laboratory/pathological exam findings. 8 In 2012, Villar, et al proposed a PTB phenotype classification that incorporates 5 components -maternal conditions, fetal conditions, placental conditions, signs of parturition initiation, and the pathway to delivery. However, this classification system has not been validated or used in practice.…”

Section: Introductionmentioning

confidence: 99%

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14: The phenotype of spontaneous preterm birth: application of a clinical phenotyping tool

Esplin

Manuck

Biggio

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective-Spontaneous preterm birth (SPTB) is a complex condition that is likely a final common pathway with multiple possible etiologies. We hypothesized that a comprehensive classification system could appropriately group women with similar STPB etiologies, and provide an explanation, at least in part, for the disparities in SPTB associated with race and gestational age at delivery.Study Design-Planned analysis of a multicenter, prospective study of singleton SPTB. Women with SPTB < 34 weeks were included. We defined 9 potential SPTB phenotypes based on clinical data, including infection/inflammation, maternal stress, decidual hemorrhage, uterine distention, cervical insufficiency, placental dysfunction, premature rupture of the membranes, maternal comorbidities, and familial factors. Each woman was evaluated for each phenotype. Delivery gestational age was compared between those with and without each phenotype. Phenotype profiles were also compared between women with very early (20.0-27.9 weeks) SPTB vs. those with early SPTB (28.0-34.0 weeks), and between African-American and Caucasian women. Statistical analysis was by t-test and chi-square as appropriate.Results-The phenotyping tool was applied to 1025 women with SPTB who delivered at a mean 30.0 (+/− 3.2) weeks gestation. Of these, 800 (78%) had ≥2 phenotypes. Only 43 (4.2%) had no phenotypes. The 281 women with early SPTB were more likely to have infection/inflammation, decidual hemorrhage, and cervical insufficiency phenotypes (all p≤0.001). African-American women had more maternal stress and cervical insufficiency but less decidual hemorrhage and placental dysfunction compared to Caucasian women (all p<0.05). Gestational age at delivery decreased as the number of phenotypes present increased.Conclusions-Precise SPTB phenotyping classifies women with SPTB and identifies specific differences between very early and early SPTB and between African-Americans and Caucasians.

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Section: Commentmentioning

confidence: 96%

Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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14: The phenotype of spontaneous preterm birth: application of a clinical phenotyping tool

Esplin

Manuck

Biggio

et al. 2015

American Journal of Obstetrics and Gynecology

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“…The lower limit of extreme preterm shifts between and within countries, and tends to be higher in lower resourced settings [1][2][3] . The World Health Organization (WHO) defines preterm birth (PTB) as any live birth before 37 completed weeks of gestation, which is further subdivided into extreme preterm (<28 weeks), very preterm (28 to <32 weeks) and late preterm (32 to <37 weeks) 4 .…”

Section: Introductionmentioning

confidence: 99%

Miscarriage, stillbirth and neonatal mortality in the extreme preterm birth window of gestation in a limited-resource setting on the Thailand-Myanmar border: A population cohort study

McGready¹,

Paw²,

Wiladphaingern³

et al. 2016

Wellcome Open Res

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The WHO definition of stillbirth uses 28 weeks' gestation as the Background: cut-point, but also defines extreme preterm birth as 24 to <28 weeks' gestation. This presents a problem with the gestational limit of miscarriage, and hence reporting of stillbirth, preterm birth and neonatal death. The objective of this study is to provide a synopsis of the outcome of a population cohort of pregnancies on the Thailand-Myanmar border between 24 to <28 weeks' gestation.Records from the Shoklo Malaria Research Unit Antenatal Clinics Methods: were reviewed for pregnancy outcomes in the gestational window of 24 to <28 weeks, and each record, including ultrasounds reports, were reviewed to clarify the pregnancy outcome. Pregnancies where there was evidence of fetal demise prior to 24 weeks were classified as miscarriage; those viable at 24 weeks' gestation and born before 28 weeks were coded as births, and further subdivided into live-and stillbirth.Between 1995 and 2015, in a cohort of 49,931 women, 0.6% (318) of Results: outcomes occurred from 24 to <28 weeks' gestation, and 35.8% (114) were miscarriages, with confirmatory ultrasound of fetal demise in 45.4% (49/108). Of pregnancies not ending in miscarriage, 37.7% (77/204) were stillborn and of those born alive, neonatal mortality was 98.3% (115/117). One infant survived past the first year of life. Congenital abnormality rate was 12.0% (23/191). Ultrasound was associated with a greater proportion of pregnancy outcome being coded as birth.In this limited-resource setting, pregnancy outcome from 24 to Conclusion:<28 weeks' gestation included: 0.6% of all outcomes, of which one-third were <28 weeks' gestation included: 0.6% of all outcomes, of which one-third were miscarriages, one-third of births were stillborn and mortality of livebirths approached 100%. In the scale-up to preventable newborns deaths, at least initially, greater benefits will be obtained by focusing on the greater number of viable newborns with a gestation of 28 weeks or more.

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The Distribution of Clinical Phenotypes of Preterm Birth Syndrome

et al. 2015

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We identified 12 preterm birth phenotypes associated with different patterns of neonatal outcomes. In 22% of all preterm births, parturition started spontaneously and was not associated with any of the phenotypic conditions considered. We believe these results contribute to an improved understanding of this complex syndrome and provide an empirical basis to focus research on a more homogenous set of phenotypes.

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The preterm birth syndrome: issues to consider in creating a classification system

Cited by 197 publications

References 39 publications

14: The phenotype of spontaneous preterm birth: application of a clinical phenotyping tool

14: The phenotype of spontaneous preterm birth: application of a clinical phenotyping tool

Miscarriage, stillbirth and neonatal mortality in the extreme preterm birth window of gestation in a limited-resource setting on the Thailand-Myanmar border: A population cohort study

The Distribution of Clinical Phenotypes of Preterm Birth Syndrome

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