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Current approaches to the detection of patients at risk for preterm delivery (PTD) have focused on the diagnosis of preterm labor. However, these approaches are complicated by treatment biases and our inability to convincingly differentiate preterm labor from Braxton-Hicks contractions. Moreover, preterm labor with intact membranes accounts for only one-half of all spontaneous PTDs since uterine contractions follow preterm premature rupture of the membranes (PROM) in an additional 50% of cases. Clinical dogma holds that the prevention of PTD requires the early detection of at risk patients. However, clinical indicators of PTD risk including cervical change, uterine contractions, vaginal bleeding, maternal demographic featuers and obstetrical history have poor sensitivity and/or specificity. Fortunately, an improved understanding of the association between preterm parturition and cervical, chorionic and decidual extracellular matrix degradation has led to a number of promising new biochemical indices of the proteolytic processes leading to PTD. These include measurement of serum collagenase activity and assessment of cervico-vaginal granulocyte elastase and oncofetal fibronectin levels. It remains to be seen, however, whether an improved detection of patients at risk will lead to a reduction in the occurrence of PTD.

HPL is a proteohormone produced by the placenta. The radio-immunological determination is presently used mainly for supervision during late pregnancy. There is no agreement regarding the diagnostic or prognostic significance of HPL during the first half of pregnancy. This may be due to the modification of the method of determination established for late pregnancy necessary for a determination during early pregnancy. The small number of results so far obtained from examinations during early pregnancy may also partly be responsible. For this reason we decided to Start by fixing the HPL range for normal early pregnancies on the basis of accurately defined groups of pregnant women and then to check whether deviating HPL values are to be found in women with uterine hemorrhage during the first half of pregnancy.