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The preterm parturition syndrome and its implications for understanding the biology, risk assessment, diagnosis, treatment and prevention of preterm birth

The syndromic nature of spontaneous labour was a concept first proposed in 1994 [1]. It has important implications for understanding the biology of preterm parturition, and also, setting realistic expectations about what programs for the prediction and prevention of preterm birth can and cannot do. The traditional view of preterm parturition has been that it is fundamentally the same process as spontaneous labour at term, and that the crucial difference is the gestational age at which these processes occur [2–4]. Another implicit assumption is that all causes of preterm labour are the same, because patients with preterm labour and intact membranes are treated with the combination of tocolytic agents and glucocorticoids worldwide. This article outlines the potential flaws in this concept, which we believe has halted progress in the prevention of preterm birth and in the treatment of preterm labour.