Ebook: Basic Mechanisms Controlling Term and Preterm Birth

The mechanisms that initiate labour (i. e. , the conversion of the quies­ cent uterus to an active and reactive organ at term) are poorly under­ stood. Of considerable importance are the factors that control preterm labour and preterm birth, with their devastating effects on society. This problem is the leading obstetrical issue. Preterm labour affects ap­ proximately 10% of all pregnant women (even higher numbers are re- Abb. I. The participants of the workshop VI Preface ported for less developed countries or where prenatal healthcare is a low priority) and it is the leading cause of morbidity and mortality of babies. Current practices to arrest preterm labour, once initiated, are in­ effective. In addition, procedures to stimulate labour and dilate the cer­ vix at term may not be used effectively. On October 19th - 21 st, 1992, a Schering Foundation Workshop took place in Berlin to discuss the "Basic Mechanisms Controlling Term and Preterm Labour". Leading scientists from Europe and North America were assembled to consider the fundamental systems which regulate the uterus and cervix during pregnancy. The topics in the sym­ posium ranged from key cellular events governing uterine contractility and cervical dilatation during labour to clinical advances and applica­ tions. This book contains the proceedings of the workshop. We were pleased to have been part of the workshop and to have been responsible for its organization.

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This book is a comprehensive summary of the present state of the art in the physiology of the pregnant uterus and discusses four main themes: First, myometrial physiology and electrophysiology; secondly, hormonal control of labour (including the cervix); thirdly, prostaglandins, infection and immune control of pregnancy; and finally, clinical management of preterm labour treatment and labour induction. It also reviews and discusses the mechanism of action of antiprogestins in the late pregnant uterus and its therapeutic potential in obstetrics. In addition, some basic questions are indicated where further research is needed in both university institutions and the pharmaceutical industry towards understanding the onset of normal and preterm labour. The organisers of the workshop and editors of this volume hope that this book will stimulate basic scientists and clinicians to continue or initiate research on preterm labour.