The article explores the concept that while term labor results from physiological activation of the common pathway of parturition, preterm labor arises from pathological signaling and activation of one or more components of this pathway. The term 'great obstetrical syndromes' is coined to reframe the concept of obstetrical disease, characterized by multiple etiology, long preclinical stage, frequent fetal involvement, adaptive clinical manifestations, and gene-environment interactions. The pathological processes implicated in preterm parturition syndrome include intrauterine infection/inflammation, uterine ischemia, uterine over-distension, abnormal allograft reaction, allergy, cervical insufficiency, and hormonal disorders. The article discusses the implications of this conceptual framework for the prevention, diagnosis, and treatment of preterm labor. Key mechanisms such as intrauterine infection, uterine ischemia, and fetal involvement are reviewed, highlighting the complexity and multifactorial nature of preterm parturition.The article explores the concept that while term labor results from physiological activation of the common pathway of parturition, preterm labor arises from pathological signaling and activation of one or more components of this pathway. The term 'great obstetrical syndromes' is coined to reframe the concept of obstetrical disease, characterized by multiple etiology, long preclinical stage, frequent fetal involvement, adaptive clinical manifestations, and gene-environment interactions. The pathological processes implicated in preterm parturition syndrome include intrauterine infection/inflammation, uterine ischemia, uterine over-distension, abnormal allograft reaction, allergy, cervical insufficiency, and hormonal disorders. The article discusses the implications of this conceptual framework for the prevention, diagnosis, and treatment of preterm labor. Key mechanisms such as intrauterine infection, uterine ischemia, and fetal involvement are reviewed, highlighting the complexity and multifactorial nature of preterm parturition.