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Preterm birth has a multifactorial
origin, the courses usually lie in one of three main
groups:
- Babies that are born because the pregnancy
cannot be prolonged due to maternal health problems (Induced
preterm birth – these babies are born by caesarean
section)
- Babies that are born because of fetal
conditions become unfavourable and they have to delivered
(Induced preterm birth – these babies are born by
cesarean section)
- Babies whose mother undergo spontaneous
(idiopathic) delivery before term (50%; 23.2-64.1%) (Spontaneous
preterm birth – these babies are born either by spontaneous
vaginal delivery or by cesarean section)
Preterm premature rupture of membranes
(PPROM) may be associated with the latter condition (25%;
7.1-51.2%)
Infrequently prematurity
can be associated with unrecognised severe congenital
anomalies.
Several studies have suggested
that infection is often associated with extremely
preterm births, while other conditions may play a role in
later preterm birth (Iams JD Clin in Perinatology 30 (2003)
651-664). Stress and lifestyle
may contribute to increase the incidence of preterm birth.
(Moutquin JM, BJOG. 2003 Apr;110 Suppl 20:30-3. PubMed).
Extremely preterm
babies have an increased risk of mortality and morbidity
in comparison with the more mature babies. A number of complications
such as life threatening infections, intraventricular haemorrhage
(IVH), necrotizing enterocolitis (NEC)
and bronchopulmonary dysplasia (BPD) increase
the risk of neurological disorders as well as other impairments
among babies who survive.
Asphyxia, hypoxia,
hypotension, hypothermia, starvation/undernutrition and inflammation
often occur in preterm babies soon after birth and tend to
alter surfactant synthesis. These conditions are associated
with worsening of the respiratory function. Modern obstetric
and neonatal care aim to minimise these disorders thereby
improving the babies’ chance of survival.
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