Journal Health of Woman. 2023. 4(167): 52-60; doi 10.15574/HW.2023.167.52

Petrenko E. V., Dubossarska Yu. O.
Dnipro State Medical University, Ukraine

For citation: Petrenko EV, Dubossarska YuO. (2023). Modern views on the etiology, pathogenesis and clinical course of spontaneous premature birth, management tactics and prevention of complications (literature review). Ukrainian Journal Health of Woman. 4(167): 52-60; doi 10.15574/HW.2023.167.52.
Article received: Jul 03, 2023. Accepted for publication: Sep 10, 2023.

A review of medical literature regarding modern views on premature birth, the main issues of etiology and pathogenesis of this pathology, diagnostic signs, clinical features of the course, management tactics and perinatal consequences, investigated prognostic markers.
A review of the medical literature regarding modern views on premature birth, the main issues of etiology and pathogenesis of this pathology, diagnostic signs, clinical features of the course, management tactics and perinatal consequences, investigated prognostic markers is provided.
Despite the active and relentless development of medical science, the issue of premature births and their impact on short- and long-term consequences for mothers and children remains an urgent issue.
Purpose – to highlight the scientists’ understanding of the etiology, pathogenesis, clinical management of premature birth, as well as to examine the available data on promising tocolytic drugs and methods of predicting premature birth.
Among the tocolytic drugs currently undergoing clinical trials, the following groups are distinguished – broad-spectrum chemokine inhibitors, prostaglandin F2α-receptor target drugs, interleukin 1 receptor antagonists, and nanoparticle platforms. If the research is successful, obstetricians and gynecologists may have a targeted drug for the treatment of preterm labor with a better safety profile than the range of drugs we have today.
Research into new laboratory prognostic markers of preterm birth, such as pregnancy-associated plasma protein A, human chorionic gonadotropin, alpha-fetoprotein, estriol, ferritin, ceruloplasmin, alkaline phosphatase, hematological markers, is also ongoing. The implementation of the above prognostic markers in clinical medicine will allow obtaining new opportunities in the early prediction of premature birth.
Sonographic approaches to predicting premature birth are being updated. In addition to the measurement of the length of the cervix, the measurement of the uterine-cervical angle and the use of cervical elastography are used.
Modern scientific achievements will allow doctors in the future at earlier stages of pregnancy to predict the possibility of premature birth and more effectively treat premature birth that has begun.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Keywords: premature birth, management tactics, laboratory prediction markers, uterine-cervical angle, cervical elastography, broad-spectrum chemokine inhibitors, prostaglandin F2α-receptor target drugs, interleukin 1 receptor antagonists, nanoparticle platforms.

REFERENCES

1. Acosta EP, Grigsby PL, Larson KB et al. (2014). Transplacental transfer of Azithromycin and its use for eradicating intraamniotic ureaplasma infection in a primate model. J Infect Dis. 209: 898. https://doi.org/10.1093/infdis/jit578; PMid:24179112 PMCid:PMC3935474

2. Ali AA, Sayed AK, El Sherif L, Loutfi GO, Mohamed Ahmed AM, Mohamed HB et al. (2019,May). Systematic review and meta-analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor. Int J Gynaecol Obstet.145 (2): 139-148. https://doi.org/10.1002/ijgo.12793; PMid:30784056

3. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins -Obstetrics. (2016). Practice bulletin № 171: Management of preterm labor. Obstet Gynecol. 128 (4): e155-e164. https://doi.org/10.1097/AOG.0000000000001711; PMid:27661654

4. Benito Vielba M, De Bonrostro Torralba C, Espiau Romera A, Roca Arquillue M, Campillos Maza JM, Castán Mateo S. (2022). Uterocervical angle as a predictor of spontaneous preterm birth in twin pregnancies. J Matern Fetal Neonatal Med. 35 (10): 1878-1885. https://doi.org/10.1080/14767058.2020.1771553; PMid:32466704

5. Chao TT, Bloom SL, Mitchell JS et al. (2011). The diagnosis and natural history of false preterm labor. Obstet Gynecol. 118: 1301. https://doi.org/10.1097/AOG.0b013e318236e7db; PMid:22105259

6. Coler BS, Shynlova O, Boros-Rausch A, Lye S, McCartney S, Leimert KB et al. (2021). Landscape of Preterm Birth Therapeutics and a Path Forward. Journal of Clinical Medicine. 10 (13): 2912. https://doi.org/10.3390/jcm10132912; PMid:34209869 PMCid:PMC8268657

7. Committee on Obstetric Practice. (2017). Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstetrics and gynecology. 130 (2): e102-e109. https://doi.org/10.1097/AOG.0000000000002237; PMid:28742678

8. Costantine MM, Weiner SJ, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). (2009). Effects of antenatal exposure to magnesium sulphate on neuroprotection and mortality in preterm infants: a meta-analysis. Obstetrics and gynecology. 114; 2 Pt 1: 354-364. https://doi.org/10.1097/AOG.0b013e3181ae98c2; PMid:19622997 PMCid:PMC2761069

9. Crowther CA, Brown J, McKinlay CJ, Middleton P. (2014, Aug 15). Magnesium sulphate for preventing preterm birth in threatened preterm labour. Cochrane Database SystRev. 8: CD001060. https://doi.org/10.1002/14651858.CD001060.pub2

10. Crowther CA, Middleton PF, Voysey M et al. (2019). Effects of repeat prenatal corticosteroids given to women at risk of preterm birth: An individual participant data meta-analysis. PLoS Med. 16: e1002771. https://doi.org/10.1371/journal.pmed.1002771; PMid:30978205 PMCid:PMC6461224

11. Deshmukh M, Patole S. (2018). Antenatal corticosteroids in impending preterm deliveries before 25 weeks' gestation. Arch Dis Child Fetal Neonatal Ed. 103: F173. https://doi.org/10.1136/archdischild-2017-313840; PMid:29208662

12. Dhok A, Ambad R, Kalambe M, Nakade M. (2020). Biomarkers for prediction of preterm delivery: A hospital-based study. J Datta Meghe Inst Med Sci Univ. 15: 16-20. https://doi.org/10.4103/jdmimsu.jdmimsu_33_20

13. Doyle LW, Crowther CA, Middleton P, Marret S. (2009). Antenatal magnesium sulphate and neurologic outcome in preterm infants: A systematic review. Obstet Gynecol. 113: 1327. https://doi.org/10.1097/AOG.0b013e3181a60495; PMid:19461430

14. Dubossarska Yu O, Puziy Ye O. (2022). Perinatal outcomes of preterm premature rupture of membranes before 36 weeks of pregnancy. Ukrainian Journal of Perinatology and Pediatrics. 3 (91): 22-28. https://doi.org/10.15574/PP.2022.91.22

15. Dubossarska ZM, Puziy Ye O. (2018). Some topical issues of preterm premature rupture of membranes. Medychni aspekty zdorovia zhinky. 7-8 (120-121): 5-7.

16. Duckitt K, Thornton S, O'Donovan OP, Dowswell T. (2014, May 8). Nitric oxide donors for treating preterm labour. Cochrane Database Syst Rev. 5: CD002860. https://doi.org/10.1002/14651858.CD002860.pub2; PMid:24809331 PMCid:PMC7138067

17. Dziadosz M, Bennett TA, Dolin C et al. (2016). Uterocervical angle: a novel ultrasound screening tool to predict spontaneous preterm birth. Am J Obstet Gynecol. 215 (3): 376.e1-376.e3767. https://doi.org/10.1016/j.ajog.2016.03.033; PMid:27018466

18. Flenady V, Reinebrant HE, Liley HG et al. (2014, Jul 20). Oxytocin receptor antagonists for inhibiting preterm labour. Cochrane Database SystRev. 3: CD004452. https://doi.org/10.1002/14651858.CD004452.pub3

19. Garite TJ, Kurtzman J, Maurel K et al. (2009). Impact of a 'rescue course' of antenatal corticosteroids: a multicenter randomized placebo-controlled trial. Am J Obstet Gynecol. 200: 248.e1. https://doi.org/10.1016/j.ajog.2009.01.021; PMid:19254583

20. Gentle SJ, Carlo WA, Tan S et al. (2020). Association of Antenatal Corticosteroids and Magnesium Sulfate Therapy With Neurodevelopmental Outcome in Extremely Preterm Children. Obstet Gynecol. 135: 1377. https://doi.org/10.1097/AOG.0000000000003882; PMid:32459430 PMCid:PMC7278037

21. Goldenberg RL, Culhane JF, Iams JD, Romero R. (2008). Epidemiology and causes of preterm birth. Lancet (London, England). 371(9606): 75-84. https://doi.org/10.1016/S0140-6736(08)60074-4; PMid:18177778

22. Haas DM, Imperiale TF, Kirkpatrick PR, Klein RW, Zollinger TW, Golichowski AM. (2009). Tocolytic therapy: a meta-analysis and decision analysis. Obstet Gynecol. 113 (3): 585-594. https://doi.org/10.1097/AOG.0b013e318199924a; PMid:19300321

23. Hornaday KK, Wood EM, Slater DM. (2022). Is there a maternal blood biomarker that can predict spontaneous preterm birth prior to labour ons et? A systematic review. PLoS ONE. 17 (4): e0265853. https://doi.org/10.1371/journal.pone.0265853; PMid:35377904 PMCid:PMC8979439

24. Iams JD. (2003). Prediction and early detection of preterm labour. Obstet Gynecol. 101:402.-22. https://doi.org/10.1016/S0029-7844(02)02505-X; PMid:12576267

25. Jahedbozorgan T, Yaghmaei M, Naserieh M. (2020). Comparison of serum ferritin levels in pregnant women with preterm and term deliveries. Immunopathol Persa. 6 (2): e25. https://doi.org/10.34172/ipp.2020.25

26. Kelly R, Holzman C, Senagore P et al. (2009). Placental vascular pathology findings and pathways to preterm delivery. Am J Epidemiol. 170: 148. https://doi.org/10.1093/aje/kwp131; PMid:19509320 PMCid:PMC2727273

27. Khambalia AZ, Collins CE, Roberts CL et al. (2015). High maternal serum ferritin in early pregnancy and risk of spontaneous preterm birth.Br J Nutr. 114 (3): 455-461. https://doi.org/10.1017/S0007114515001932; PMid:26146276

28. Kovacevich GJ, Gaich SA, Lavin JP et al. (2000). The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labour or preterm premature rupture of membranes. Am J Obstet Gynecol. 182: 1089. https://doi.org/10.1067/mob.2000.105405; PMid:10819836

29. Kurban Y, Alan Y, Alan M et al. (2020). A new marker in preterm labour: RDW and MPV. Obstet Gynecol Int J. 11 (6): 366-372. https://doi.org/10.15406/ogij.2020.11.00538

30. Kurban Y, Alan Y, Uyar İ, Atak Z, Aydemir Ö, Öktem A. (2021). Investigation of neutrophil/lymphocyte ratio and mean platelet volume in patients diagnosed with preterm labour. Paediatr Respir Rev. 40: 39-43. https://doi.org/10.1016/j.prrv.2020.05.008; PMid:33342727

31. Lafi F, Reichman O, Gdansky E, Urman M, Sela HY, Boldes R. (2019). Association between elastogram of uterine cervix to preterm delivery among pregnant women at risk for preterm labour. Abstracts. European Journal of Obstetrics & Gynecology and Reproductive Biology. 234: e132-e181. https://doi.org/10.1016/j.ejogrb.2018.08.459

32. Manasova HS, Nitochko KO, Shapoval MV. (2023). Peredchasni polohy. Navch. posib. Ternopil: Krok. 2023: 10-25.

33. Mc Evoy C, Schilling D, Peters D et al. (2010). Respiratory compliance in preterm infants after a single rescue course of antenatal steroids: a randomized controlled trial. Am J Obstet Gynecol. 202: 544.e1. https://doi.org/10.1016/j.ajog.2010.01.038; PMid:20227053 PMCid:PMC2878893

34. Nitochko KO, Manasova HS, Shpak IV, Zhelezov DM. (2023). Peredchasni polohy: prohnozuvannia, profilaktyka ta shliakhy pokrashchennia perynatalnykh naslidkiv. Metodychni rekomendatsii. Odesk. nats. med. un-t. Odesa: ONMedU. 2023: 14-17.

35. Oros D, Strunk M, Breton P et al. (2017). Altered gene expression in human placenta after suspected preterm labour. Placenta. 55: 21-28. https://doi.org/10.1016/j.placenta.2017.04.025; PMid:28623969

36. Palacio M, Kuhnert M, Berger R, Larios CL, Marcellin L. (2014). Meta-analysis of studies on biochemical marker tests for the diagnosis of premature rupture of membranes: comparison of performance indexes. BMC Pregnancy Childbirth. 14: 183. https://doi.org/10.1186/1471-2393-14-183; PMid:24884494 PMCid:PMC4229884

37. Patberg ET, Wells M, Vahanian SA et al. (2021). Use of cervical elastography at 18 to 22 weeks' gestation in the prediction of spontaneous preterm birth. Am J Obstet Gynecol. 225: 525.e1-9. https://doi.org/10.1016/j.ajog.2021.05.017; PMid:34051170

38. Roberts D, Brown J, Medley N, Dalziel SR. (2017). Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 3: CD004454. https://doi.org/10.1002/14651858.CD004454.pub3; PMid:28321847 PMCid:PMC6464568

39. Vogel I, Thorsen P, Curry A, Uldbierg N. (2005). Biomarkers for the prediction of preterm delivery. Acta Obstet Gynecol Scand. 84: 516-525. https://doi.org/10.1111/j.0001-6349.2005.00771.x; PMid:15901257

40. Vogel JP, Nardin JM, Dowswell T et al. (2014, Jul 11). Combination of tocolytic agents for inhibiting preterm labour. Cochrane Database Syst Rev.7:CD006169. https://doi.org/10.1002/14651858.CD006169.pub2; PMid:25010869 PMCid:PMC10657484

41. Walani SR. (2020). Global burden of preterm birth. Int J Gynecol Obstet.150: 31-33. https://doi.org/10.1002/ijgo.13195; PMid:32524596

42. Wilson A, Hodgetts-Morton VA, Marson EJ, Markland AD et al. (2022). Tocolytics for delaying preterm birth: a network meta-analysis (0924). The Cochrane database of systematic reviews. 8(8): CD014978. https://doi.org/10.1002/14651858.CD014978.pub2; PMid:35947046 PMCid:PMC9364967

43. Wolf HT, Huusom LD, Henriksen TB et al. (2020). Magnesium sulphate for fetal neuroprotection at imminent risk for preterm delivery: a systematic review with meta-analysis and trial sequential analysis. BJOG. 127: 1180. https://doi.org/10.1111/1471-0528.16238; PMid:32237069