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Science. 2014 Aug 15;345(6198):760-5. doi: 10.1126/science.1251816. Epub 2014 Aug 14.

Preterm labor: one syndrome, many causes.

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Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD, Wayne State University/the Detroit Medical Center, Detroit, MI, USA. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA. Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
Division of Reproductive Sciences, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Obstetrics, Gynecology and Reproductive Sciences, Department of Anatomy, and Center for Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.


Preterm birth is associated with 5 to 18% of pregnancies and is a leading cause of infant morbidity and mortality. Spontaneous preterm labor, a syndrome caused by multiple pathologic processes, leads to 70% of preterm births. The prevention and the treatment of preterm labor have been long-standing challenges. We summarize the current understanding of the mechanisms of disease implicated in this condition and review advances relevant to intra-amniotic infection, decidual senescence, and breakdown of maternal-fetal tolerance. The success of progestogen treatment to prevent preterm birth in a subset of patients at risk is a cause for optimism. Solving the mystery of preterm labor, which compromises the health of future generations, is a formidable scientific challenge worthy of investment.

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