PRETERM BIRTH Edited by Offer Erez Preterm Birth http://dx.doi.org/10.5772/46172 Edited by Offer Erez Contributors Erdener Ozer, Anneloes Van Baar, Marjanneke De Jong, Marjolein Verhoeven, Fernando Oliveira Costa, Offer Erez, Saba Masho, Heather Joan Linton Brooks, Michelle McConnell Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Ana Pantar Technical Editor InTech DTP team Cover InTech Design team First published January, 2013 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Preterm Birth , Edited by Offer Erez p. cm. ISBN 978-953-51-0952-5 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface VII Section 1 Mechanisms of Preterm Parturition 1 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 135 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 Preface 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 pre‐ maturity reached 26.2 billion US dollars. Preterm labor and delivery has a short and long term effect on the health of the fetus, neo‐ nate, 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 tai‐ lor the desired treatment that is suitable to the mechanisms leading to prematurity in a spe‐ cific 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 associat‐ ed with preterm birth. Although the results of the histopathological examination of the pla‐ centa 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 clini‐ cian in preventing the reoccurrence of prematurity in subsequent pregnancies. The second section of the book deals with short and long term effect of prematurity. Accu‐ mulating 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 intra- ventricular hemorrhage, bronchopulmonary dysplasia and necrotizing enterocolitis. This as‐ sociation 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 develop‐ mental 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 par‐ turition to the entire medical and scientific community. Offer Erez Soroka University Medical Center Ben Gurion University of the Negev Beer Sheva, Israel PrefaceVIII Section 1 Mechanisms of Preterm Parturition [...]... periodontal status of women during pregnancy, the risk factors associ‐ ated with periodontal disease and preterm birth, the biological plausibility of periodontal infection inducing preterm birth, the surrogate microbiological, immunological and biochem‐ ical markers for periodontal status and preterm birth, and data from animal and human studies, as well as a critical analysis of the current scientific... different methodological designs 5 Preterm birth and low birth weight 5.1 Conceptual aspects Since March 1935, after a meeting in Chicago – USA, the American Academy of Pediatrics defined as preterm infants all newborn infants weighing 2,500 grams (g) or less [45] Some time later, however, it became apparent that there were differences between gestational age and birth weight due IUGR Because of this,... of PTB, which can rise up the risk to three times 11 12 Preterm Birth However, according to these authors, more than 50% of PTBs are idiopathics In the studies presented in the next sections, the reported risk estimates presented in the literature for each of these factors will be presented [52] 5.3 Maternal infections and preterm birth and low birth weight Offenbacher et al [23] and Gibbs et al [53],... uterine or cervical defects Thus, the control group (G1) was composed by 1046 women with adequate gestation period ( ≥ 37 weeks), and the PTB group was composed by 146 women with gestation period between 32 and 36 weeks (G2) Another group, composed by 15 women with gestation period < 32 weeks, was de‐ termined to be extreme preterm birth (G3) The results showed that periodontitis was as‐ sociated with... periodontal status by full-mouth evaluation or PD, CAL, and radiographic bone loss evaluation; (b) assessment of birth weight based on weight measured immediately after birth in the delivery room or medical intensive care unit; (c) assessment of gestational age based on the date of last menstrual period or by early ultrasound Failing to accom‐ plish these assessments, gestational age should be made by the pediatrician... mediators, growth factors, and other potent cytokines that can induce the occurrence of PTB (Figure 1) Figure 1 Biological plausibility: association between maternal periodontitis and preterm birth (see attachment) 9 10 Preterm Birth PTB and LBW represent a major public health problem, ranking among the leading causes of infant mortality In addition to a great increase in the chance of death during perinatal... Disease and Preterm Birth http://dx.doi.org/10.5772/54977 Therefore, some studies reported that the presence of periodontalpathogenic bacteria such as Porphyromonas gingivalis, Fusobacterium nucleatum in the amniotic fluid, placenta, and membranes of pregnant women were associated with adverse pregnancy outcomes, including preterm labor and premature rupture of membranes Findings from the studies by Offenbacher... groups: G1 – composed by women who received plaque control, scaling and root planing and periodontal maintenance monthly before 28 weeks gestation; and G2 – composed by women who received periodontal treatment only after delivery Data analysis was performed in a final sample of 351 mothers who gave birth to live infants, 14 PTB (3.98%) and 8 LBW (2.27%) The G1 group, composed by 163 women, showed 2... inflammatory stimulus induces a state of activity of uterine smooth muscle by increasing contractility, cervical dilatation, and triggering labor Infections and inflammation may also induce damage in the placenta, leading to reduced fetal perfusion, IUGR, and fetal distress 6 Periodontitis as a risk factor for preterm birth and low birth weight The current concept of pathogenesis of periodonitiss ponts... pediatrician through physical examination The selected studies showed OR estimates for the association be‐ 21 22 Preterm Birth tween maternal PD and PPT and LBW ranging from 4.4 to 7.9 However, authors con‐ cluded that the evidence for this association were still limited After a selection of 660 studies by Scannapieco et al [86], 12 studies met the inclusion criteria Authors concluded that it is unclear whether . PRETERM BIRTH Edited by Offer Erez Preterm Birth http://dx.doi.org/10.5772/46172 Edited by Offer Erez Contributors Erdener Ozer,. www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Preterm Birth , Edited by Offer Erez p. cm. ISBN 978-953-51-0952-5 free online editions of InTech Books