Patologie materno-fetali nei parti tra 22-25 settimane

The survival rate for infants born preterm at the threshold of viability has improved over the past two decades. However, the incidence of moderate or severe, neurodevelopmental disability in surviving children is still high. Approximately 20-40% of preterm birth are the result of physician's decision for maternal or fetal indications, and the remainder follow spontaneous onset of labor or rupture of the membranes. Iatrogenic delivery is mainly due to preeclampsia and IUGR which share the common pathway of impaired placenta implantation. Intrauterine infection is present in most cases of extremely spontaneous preterm birth. Bacteria may reach the uterus by migrating from the abdominal cavity, through hematogenous spread, or from the vagina through the cervix. Inhibition of contractions has been the focus of therapeutic approaches. Tocolysis has allowed to delay delivery long enough to administer corticosteroids which improve neonatal outcome, but has proven ineffective in preventing preterm delivery. Future efforts to prevent prematurity should focus on primary and secondary prevention.