BEDSIDE PHYSIOLOGY Understanding pre-term birth

Pre-term birth occurs in 5% to 10% of all pregnancies in North America. This figure may be higher in certain population groups and has not decreased over the past 20 to 30 years. Although some pre-term births may be elective, approximately 30% occur in association with an underlying infectious process, and about 50% are idiopathic pre-term births of unknown cause. Pre-term birth is associated with a 70% rate of neonatal death and up to 75% of neonatal morbidity. Infants born before term have an increased rate of cerebral palsy, neurologic handicap and pulmonary disorders. The costs of caring for pre-term babies in the United States has been estimated at $8 billion annually. At present, there are no effective diagnostic indicators of pre-term birth, and there are no effective treatments for this condition. Thus, the current direction of research remains to understand the underlying biochemistry of the birth process and to utilize that information to develop better diagnostic indicators and improved methods of therapy.