From structural modalities in perinatal medicine to the frequency of preterm birth
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REVIEW
From structural modalities in perinatal medicine to the frequency of preterm birth Philipp Deindl 1 & Anke Diemert 2 Received: 16 April 2020 / Accepted: 1 July 2020 # The Author(s) 2020
Abstract Preterm birth is a global health problem that affects 11% of all live births: it remains a significant cause of death and an important cause of long-term loss of human potential among survivors all around the world. In the last decade, many developed countries have seen an increase in the rate of infants born preterm. Various theoretical and practical concepts have been discussed that aim to optimize the perinatal care of preterm infants and their mothers. These include the definition of hospitals with different levels of care, the regionalization of care, the creation of large care units with high case numbers, and a high level of expertise. This review article focuses on the connection between health care structures and different aspects of preterm birth. Furthermore, this review article highlights the fact that preterm birth is a heterogeneous syndrome with many underlying pathologies and that the causality for a large number of cases remains unexplained. There is still a significant knowledge gap concerning the actual drivers of spontaneous preterm birth, and future research particularly in parturition immunology as well as genetics of prematurity will be essential to identify new targets for therapy. Keywords Preterm birth . Prematurity . Neonatal care . Prenatal care . Cervical insufficiency . Progesterone . Immunology of parturition . Risk factors prematurity . Genetics of prematurity
Abbreviations VLBW Very low birth weight ELBW Extremely low birth weight VPT Very preterm NICU Neonatal intensive care unit PTB Preterm birth
This article is a contribution to the special issue on Preterm birth: Pathogenesis and clinical consequences revisited - Guest Editors: Anke Diemert and Petra Arck * Anke Diemert [email protected] Philipp Deindl [email protected] 1
Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2
Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
Introduction Worldwide, about 11% of all children are born preterm, resulting in a total of 15 million children born before the 37th week of gestation. In many countries, the rate of preterm births is increasing, and the survival rate of preterm babies has dramatically improved in developed countries [1–3]. The survival of children born pretermly depends on the available resources in obstetrics and neonatal care as wells as on the attitudes towards viability in the individual countries [4]. Preterm birth represents a significant cause of death and can lead to serious harm to survivors all around the world [2]. Especially, the groups of extremely preterm (EPT) and extremely low birth weight (ELBW) babies require considerable resources and highly specialized treatment. Pret
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