Preterm birth is among the most complex and important challenges in obstetrics. Despite decades of research and clinical advancement, approximately 1 in 10 newborns in the United States is born prematurely. These newborns account for approximately three-quarters of perinatal mortality and more than one half of long-term neonatal morbidity, at significant social and economic cost (1-3). Because preterm birth is the common endpoint for multiple pathophysiologic processes, detailed classification schemes for preterm birth phenotype and etiology have been proposed (4, 5). In general, approximately one half of preterm births follow spontaneous preterm labor, about a quarter follow preterm prelabor rupture of membranes (PPROM), and the remaining quarter of preterm births are intentional, medically indicated by maternal or fetal complications. There are pronounced racial disparities in the preterm birth rate in the United States. The purpose of this document is to describe the risk factors, screening methods, and treatments for preventing spontaneous preterm birth, and to review the evidence supporting their roles in clinical practice. This Practice Bulletin has been updated to include information on increasing rates of preterm birth in the United States, disparities in preterm birth rates, and approaches to screening and prevention strategies for patients at risk for spontaneous preterm birth.

中文翻译：

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自然早产的预测和预防：ACOG 实践公告，第 234 号。

早产是产科最复杂和最重要的挑战之一。尽管经过了数十年的研究和临床进展，美国仍有大约十分之一的新生儿早产。这些新生儿约占围产期死亡率的四分之三和长期新生儿发病率的一半以上，造成了巨大的社会和经济成本 (1-3)。由于早产是多种病理生理过程的共同终点，因此已经提出了早产表型和病因的详细分类方案 (4, 5)。一般来说，大约一半的早产是自发性早产，大约四分之一是胎膜早破（PPROM），其余四分之一的早产是故意的，医学上有母体或胎儿并发症的迹象。美国的早产率存在明显的种族差异。本文件的目的是描述预防自发性早产的危险因素、筛查方法和治疗方法，并回顾支持其在临床实践中作用的证据。本实践公告已更新，包括有关美国早产率上升、早产率差异以及有自发性早产风险的患者的筛查方法和预防策略的信息。