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Cited by 179Preterm Birth and ChorioamnionitisInfant Development and Preterm CareMaternal and Perinatal Health Interventions

The DOI matches its Crossref record; 51 of the 51 references it cites were found in a registry or an index.

Risk stratification and pathological mechanisms in preterm delivery

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Lockwood, Charles J., Kuczynski, Edward·2001·Paediatric and Perinatal Epidemiology
DOI 10.1046/j.1365-3016.2001.00010.x
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Abstract

The delivery of infants before 37 weeks gestation is a leading cause of perinatal mortality and morbidity in the United States. Traditional methods of predicting women at risk relying on obstetric history or premonitory symptoms (detected clinically or by tocodynamometry) are neither sensitive nor specific. Recent approaches to predicting preterm delivery have included sonographic measurement of cervical length and various biochemical assays. Although more sensitive than traditional methods, none of these alone exhibits sufficient accuracy to warrant widespread use. We contend that the failure of current approaches to predicting preterm delivery reflects an inadequate understanding of the underlying pathogenesis. Clinical and experimental evidence support the concept that most cases of preterm delivery reflect four pathogenic processes, which share a common final biological pathway leading to uterine contractions and cervical changes with or without premature rupture of membranes. These pathogeneses are: (1) activation of the maternal or fetal hypothalamic‐pituitary‐adrenal axis; (2) decidual‐chorioamniotic or systemic inflammation; (3) decidual haemorrhage (i.e. abruption); and (4) pathological distention of the uterus. Our research seeks to combine the most useful biophysical and biochemical markers of such processes with optimal clinical and epidemiological predictors into a composite, easily applied risk tool. This integrated approach has the potential to identify at‐risk asymptomatic patients with high sensitivity, specificity, and positive and negative predictive values, and also to ascertain underlying pathogenic processes that can lead to targeted therapy. To accomplish these goals, we employ logistic regression and artificial neural network models to assess and apply the appropriate weight to markers associated with each of the above pathogenic pathways, in addition to markers of the final common pathway leading to fetal membrane rupture, cervical extracellular matrix degradation, and myometrial activation. By combining these markers, we expect ultimately to produce a predictive model that is more robust than any existing method, and that identifies the relative contribution of each pathogenic process. Further analysis of this model using a neural network will enable us to identify asymptomatic patients destined to deliver preterm with high sensitivity, specificity, positive and negative predictive values, and to assess the relative contribution of each of the four distinct pathogeneses to this preterm delivery risk.

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Crossref · 10.1046/j.1365-3016.2001.00010.x

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  • Increases of CRH early in pregnancy have predicted the onset of preterm labor.

    “Increases of CRH early in pregnancy have predicted the onset of preterm labor in ours and other’s results [20–25].”

    From The mastery lifestyle intervention to reduce biopsychosocial risks for pregnant Latinas and African Americans and their infants: protocol for a randomized controlled trial (2022) · cites this paper as [25]

    The Introduction identifies CRH assays among approaches to predicting preterm delivery, and the Overview lists CRH levels as a candidate predictor. Neither passage says that increases early in pregnancy have been shown to predict the onset of preterm labor; the paper instead describes limits on the reliability of individual markers. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The chronicity of stress is particularly important in relation to the initiation of early labor.

    “The chronicity of stress is particularly important in relation to the initiation of early labor [25].”

    From The mastery lifestyle intervention to reduce biopsychosocial risks for pregnant Latinas and African Americans and their infants: protocol for a randomized controlled trial (2022) · cites this paper as [25]

    The Introduction identifies activation of the maternal or fetal HPA axis as a pathway initiating preterm delivery. The section 'Cervical length, stress, and race' reports an association between perceived stress and shorter cervices, but only among women who delivered at term. Neither passage assesses the chronicity of stress or establishes that it is particularly important in initiating early labor. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 4

  1. Lockwood CJ, 1993, New approaches to the prediction of preterm delivery., Journal of Perinatal Medicine, 21, 441
  2. 10.1210/jc.81.8.3119 · DOI
  3. DijkstraK KimA KuczynskiE LockwoodCJ.The presence of interstitial collagenase in vaginal secretions of women during pregnancy as a predictor of premature birth. (Abstract).American Journal of Obstetrics and Gynecology1998;178(Suppl. 1):S189.
  4. RosenDB BurkeHB GoodmanPH.Improving prediction accuracy using a calibration postprocessor.Proceedings of the World Congress on Neural Networks San Diego CA September 1996. Hillsdale NJ: Lawrence Erlbaum Associates Inc.1996; pp.1215–1220.

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Metadata

Authors
Lockwood, C. J., & Kuczynski, E.
Affiliations
  • NYU Langone Health (US)
  • New York University (US)
ORCID
Lockwood, Charles J.
Venue
Paediatric and Perinatal Epidemiology
Publisher
Wiley
Published
2001-07
Volume
15
Issue
s2
Pages
78-89
ISSN
  • 0269-5022 (ISSN-L)
  • 1365-3016
DOI
10.1046/j.1365-3016.2001.00010.x
OpenAlex
W2032061537
Cited by
179
References
51
Citations by year
2026: 4 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 7 · 2019: 6 · 2018: 9 · 2017: 14 · 2016: 6 · 2015: 9 · 2014: 6 · 2013: 13 · 2012: 7
FWCI
2.03
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 175 d)
Locations
  • Paediatric and Perinatal Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
March of Dimes Foundation
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Preterm Birth and Chorioamnionitis
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
preterm birth, preterm birth prediction, risk stratification, hypothalamic-pituitary-adrenal axis, inflammation, uterine distension, premature rupture of membranes, artificial neural networks, logistic regression
MeSH terms
Adult, Female, Gestational Age, Humans, Obstetric Labor, Premature, Pregnancy, Prospective Studies, Surveys and Questionnaires, Socioeconomic Factors, Vaginal Smears, Cohort Studies, Logistic Models, Ultrasonography, Prenatal, Neural Networks, Computer, Vaginosis, Bacterial, Risk Assessment

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