早産予防管理の動向

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  • Trend of preventive management of preterem birth

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<p> Preterm birth is a major cause of perinatal morbidity and mortality. A short cervical length on transvaginal ultrasound examination in the mid-trimester is one of the best predictors of preterm birth. Many methods are now being reported to predict preterm labor and preterm delivery, and many treatments to prevent preterm labor and preterm delivery. When cervical shortening is diagnosed, cervical cerclage has been proposed to prevent preterm birth, although several randomized trials have not supported this practice. As inflammation plays a central role in the pathology of preterm delivery, suppressing such inflammation as cervicitis and chorioamnionitis is crucial for treating preterm delivery. However, Mg sulfate and beta-2 agonists, which are currently used to treat threatened preterm delivery by inhibiting uterine contractions, do not reduce inflammatory response. As a result, Mg sulfate and beta-2 agonist therapy are considered to only treat the symptoms of cervicitis and chorioamnionitis. The use of antibiotic and anti-inflammatory therapies to treat cervicitis and chorioamnionitis has been recently reported. From these background and the various causes of premature birth, it is hard to make a uniform explanation of the mechanism. It is not uncommon for premature birth to occur due to medical reasons or diagnosis due to maternal complications, etc., due to an increase in maternal age. There is also an iatrogenic aspect due to an increase in multiple births and in utero fetal growth retardation due to an increase in assisted reproduction treatment. While focusing on these iatrogenic premature births, it remains important to understand the cascade of premature births based on traditional infections and inflammation. It is no doubt that reducing premature birth itself is important. However, there are a number of researches to prevent premature labor and to treat preterm birth.</p>

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