Recurrent preterm birth

Abstract

Recurrent preterm birth is frequently defined as two or more deliveries before 37 completed weeks of gestation. The recurrence rate varies as a function of the antecedent for preterm birth: spontaneous versus indicated. Spontaneous preterm birth is the result of either preterm labor with intact membranes or preterm prelabor rupture of the membranes. This article reviews the body of literature describing the risk of recurrence of spontaneous and indicated preterm birth. Also discussed are the factors which modify the risk for recurrent spontaneous preterm birth (a short sonographic cervical length and a positive cervicovaginal fetal fibronectin test). Patients with a history of an indicated preterm birth are at risk not only for recurrence of this subtype, but also for spontaneous preterm birth. Individuals of black origin have a higher rate of recurrent preterm birth.

Figure 1

Pathological processes implicated in the preterm parturition syndrome. (Reproduced with permission from Romero et al, with permission.) Romero R, Espinoza J, Mazor M, Chaiworapongsa T. The preterm parturition syndrome. In: Critchely H, Bennett P, Thornton S, editors. Preterm Birth. London: RCOG Press; 2004. p. 28–60.

Figure 2

Concordance in timing of preterm (20–34 6/7 weeks’ gestation) birth in Missouri to a mother with previous preterm birth, 1989–1997. The line represents the expected Gaussian curve if concordance in timing is a normally distributed event. The bars represent the timing for each preterm birth after the initial preterm birth for A, all mothers, B, Caucasians, or C, African American in correlation with the expected normal curve. (Reproduced with permission from Kistka et al^x, with permission.) Kistka ZA, Palomar L, Lee KA, Boslaugh SE, Wangler MF, Cole FS et al. Racial disparity in the frequency of recurrence of preterm birth. Am J Obstet Gynecol 2007;196:131.