Open Access Medical Books


Edited by Offer Erez .

The preterm parturition syndrome is one of the major obstetrical complications of our time.
This syndrome is either spontaneous or indicated, and its prevalence in the USA rose up to 
12% of all deliveries. The Institute of Medicine estimated that in 2005 the annual cost of prematurity 
reached 26.2 billion US dollars.
Preterm labor and delivery has a short and long term effect on the health of the fetus, neonate, 
child and adult. Preterm neonates are more likely to die within the first year of life and 
have a higher rate of long term complications including cerebral palsy and autism. Thus, 
understanding the mechanisms leading to preterm parturition may assist the clinician to tailor 
the desired treatment that is suitable to the mechanisms leading to prematurity in a specific 
patient. In the first section of this book we present an update on the association of 
periodontal disease, maternal stress, and activation of the hemostatic system and preterm 
parturition. These chapters convey the most updated evidence in each field regarding its 
contribution to preterm delivery and carry within them the information for further research 
in these fields. The closing chapter of this section describes the placental pathology associated 
with preterm birth. Although the results of the histopathological examination of the placenta 
are often disregarded, it is an important tool in the understanding of the mechanisms 
leading to preterm delivery. Moreover, since preterm parturition, spontaneous as well as 
indicated, is a recurrent disease, the results of the placental examination may assist the clinician 
in preventing the reoccurrence of prematurity in subsequent pregnancies.
The second section of the book deals with short and long term effect of prematurity. Accumulating 
evidence suggests that the processes leading to preterm birth have an impact on 
the complications of prematurity. Indeed, chronic maternal infectious morbidity predispose 
to preterm delivery. Moreover, fetuses who were exposed in-utero to chronic infection or 
inflammation are at increased risk to develop severe sequel of prematurity including intraventricular 
hemorrhage, bronchopulmonary dysplasia and necrotizing enterocolitis. This association 
is eloquently described in the chapter dealing with the connection between 
inflammation and necrotizing enterocolitis. The second chapter in this section deals with the
long term developmental outcome of children following late preterm birth. This is one of the 
most important topics in modern obstetrics. The rising percentage of preterm deliveries in 
the past decades is derived mainly from the increase in the rate of late preterm birth. In fact 
the rate of early preterm birth before 32 weeks of gestation is almost constant. In contrast, 
there is a sharp increase in late preterm deliveries. The major force that drives the rate of late 
preterm birth upward is indicated in, some may call it, iatrogenic preterm deliveries. This 
medical intervention is associated with increased neonatal survival rate and some reduction 
in maternal morbidity especially due to preeclampsia, obstetrical hemorrhage as placenta 
previa, and infection associated with preterm PROM. Yet this benefit does not go without a 
price, indeed, children born between 32-36 weeks of gestation have a higher rate of developmental 
and school problems than their peers who were born at term. This last chapter brings 
forward another aspect that is usually overlooked in obstetrical research and that is the long 
term outcome of perinatal complication.
This book is the second in the InTech series regarding preterm birth and like its predecessor 
deals with maternal and neonatal aspects of this obstetrical syndrome. Moreover, in this 
open access series we are able to bring the most update information regarding preterm parturition 
to the entire medical and scientific community.

Offer Erez
Soroka University Medical Center
Ben Gurion University of the Negev
Beer Sheva, Israel


Section 1 Mechanisms of Preterm Parturition .

Chapter 1 Interrelation Between Periodontal Disease and Preterm Birth 3
Fernando Oliveira Costa, Alcione Maria Soares Dutra Oliveira and Luís Otávio Miranda Cota

Chapter 2 Preterm Birth and Stressful Life Events 41
Susan Cha and Saba W. Masho

Chapter 3 The Role of the Coagulation System in Preterm Parturition 83
Vered Klaitman, Ruth Beer-Wiesel, Tal Rafaeli, Moshe Mazor and Offer Erez

Chapter 4 Placenta in Preterm Birth 109
Erdener Ozer

Section 2 Short and Long Term Effect of Preterm Birth .

Chapter 5 Microbes and the Inflammatory Response in Necrotising Enterocolitis 137
Heather J.L. Brooks, Michelle A. McConnell and Roland S. Broadbent

Chapter 6 Moderate Preterm Children Born at 32-36 Weeks Gestational Age Around 8 Years of Age: Differences Between Children with and Without Identified Developmental and School
Problems 175
Anneloes L. van Baar, Marjanneke de Jong and Marjolein Verhoeven

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