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The implicit paradigm that has governed the clinical management and investigation of preterm parturition is that term and preterm labor are fundamentally the same processes except for the gestational age at which they occur. Indeed, term and preterm labor share a common terminal pathway composed of myometrial contractility, cervical ripening, and decidual/membrane activation (Fig. 1). Clinical tests to identify the patient at risk for preterm birth have focused on detection of premature activation of each of these components (Fig. 2). For example, uterine activity monitoring, ultrasonographic examination of the cervix, and measurement of fetal fibronectin can be used to detect myometrial activation, cervical ripening, and membrane/decidual activation, respectively. Interventions to prevent preterm birth also are also aimed at the common terminal pathway. Pharmacologic inhibition of uterine contractility (ie, tocolysis) and cervical cerclage have been proposed as methods to prevent...

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