The preterm birth syndrome: a prototype phenotypic classification - 02/02/12

Doi : 10.1016/j.ajog.2011.10.866

Jose Villar, MD, MSc, MPH, FRCOG ^a, Aris T. Papageorghiou, MBChB, MRCOG ^a, Hannah E. Knight, MSc ^a, Michael G. Gravett, MD ^b, Jay Iams, MD ^c,^⁎ , Sarah A. Waller, MD ^b, Michael Kramer, MD ^d, Jennifer F. Culhane, PhD, MPH ^e, Fernando C. Barros, PhD ^f, Agustín Conde-Agudelo, MD, MPH ^g, Zulfiqar A. Bhutta, MBBS, FRCP, FRCPCH, FCPS, PhD ^h, Robert L. Goldenberg, MD ⁱ
^a Nuffield Department of Obstetrics and Gynaecology, and Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
^b Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; and Global Alliance to Prevent Prematurity and Stillbirth, Seattle Children's, Seattle, WA
^c Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
^d Departments of Pediatrics and of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
^e Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
^f Post-Graduate Course in Health and Behavior, Catholic University of Pelotas, RS, Brazil
^g Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI
^h Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
ⁱ Department of Obstetrics and Gynecology, Drexel University, Philadelphia, PA

Reprints: Jay D. Iams, MD, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH 43210-1228

Résumé

Preterm birth is a syndrome with many causes and phenotypes. We propose a classification that is based on clinical phenotypes that are defined by ≥1 characteristics of the mother, the fetus, the placenta, the signs of parturition, and the pathway to delivery. Risk factors and mode of delivery are not included. There are 5 components in a preterm birth phenotype: (1) maternal conditions that are present before presentation for delivery, (2) fetal conditions that are present before presentation for delivery, (3) placental pathologic conditions, (4) signs of the initiation of parturition, and (5) the pathway to delivery. This system does not force any preterm birth into a predefined phenotype and allows all relevant conditions to become part of the phenotype. Needed data can be collected from the medical records to classify every preterm birth. The classification system will improve understanding of the cause and improve surveillance across populations.

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Key words : phenotype, preterm birth

Plan

The preterm birth phenotype

How the collected data are used to drive the new classification

Preterm birth phenotypes that can be identified by the 5 components

The way forward: empiric validation of the new system

Research implications of the use of a phenotypic classification system of preterm birth

	Supported by the Bill & Melinda Gates Foundation and the Global Alliance to Prevent Prematurity and Stillbirth (an initiative of Seattle Children's), and by INTERGROWTH-21st grant no. 49038 from the Bill & Melinda Gates Foundation to the University of Oxford.
	The authors report no conflict of interest.

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Vol 206 - N° 2

P. 119-123 - février 2012 Retour au numéro

Article précédent

The preterm birth syndrome: issues to consider in creating a classification system
Robert L. Goldenberg, Michael G. Gravett, Jay Iams, Aris T. Papageorghiou, Sarah A. Waller, Michael Kramer, Jennifer Culhane, Fernando Barros, Augustin Conde-Agudelo, Zulfiqar A. Bhutta, Hannah E. Knight, Jose Villar

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Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data
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The preterm birth syndrome: a prototype phenotypic classification - 02/02/12

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