Flores, Doris Glenn V.

PATHOPHYSIOLOGY OF PRETERM BIRTH

1. Maternal stress

2. Uterine abnormalities

3. Infection

4. Lack of progesterone
dehydrogenase
There are several pathophysiological factors that may trigger the events leading to

preterm birth.

• Maternal stress

• Uterine abnormalities

• lack of prostaglandin dehydrogenase

• hemorrhage

• Infections

These factors can act individually or in various combinations to induce uterine

contractions (through production of prostaglandins, endothelin, increase the

estrogen/progesterone balance increased density of oxytocin receptors or gap

junctions):

 By activation of proteolytic enzymes through interleukin-8 triggered

neutrophil ctivation which promotes cervical maturation.

 By inducing proteolytic degradation of adhering proteins between

the chorion and the decidua with subsequent release of fetal

fibronectin.

 By causing cellular death (apoptosis) in the chorioamniotic

membranes and breakdown of extracellular collagen and

mucopolysaccharides which causes premature rupture of

membranes.
Infection seems to be the most important etiology in early gestation, whereas over

distension and maternal stress play more important roles at later gestation

There is a strong correlation between intraamniotic cytokine-mediated

inflammation and preterm delivery both in PTL and PPROM patients. Furthermore, the

risk of neonatal neurologic morbidity seems to be higher in spontaneous preterm birth

(often related to infections) compared to indicated delivery related to maternal or fetal

complications demonstrated that the occurrence of periventricular/intraventricular

hemorrhage or periventricular leukomalacia.

SOURCES:

Pilliterri, Adelle. 2007. Maternal and Child Health Nursing: Care of the Childbearing and
the Childrearing Family. Lippincott Williams and Wilkins.

http://www.scribd.com/doc/37814606/Preterm-Birth