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Pretem Labor

Pretem Labor. Ramzy Nakad , MD. Preterm Birth. Definition: Birth that occurs prior to completion of 37 weeks of gestation. Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization .

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Pretem Labor

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  1. Pretem Labor RamzyNakad, MD

  2. Preterm Birth • Definition: Birth that occurs prior to completion of 37 weeks of gestation. • Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization . • In the United States, approximately 12% of all live births occur before term, and preterm labor preceded approximately 50% of these preterm births.

  3. Preterm Birth • Account for approximately 70% of neonatal deaths and 36% of infant deaths as well as 25–50% of cases of long-term neurologic impairment in children. • Estimated annual cost of preterm birth in the United States to be $26.2 billion or more than $51,000 per premature infant.

  4. Preterm Birth • Classified into two main categories. • Spontaneous: Approximately 40-50% are due to spontaneous preterm labor with intact membranes and 25-40% due to preterm premature rupture of the membranes. • Indicated: Deliberate intervention for variety of maternal or obstetric indications 20-30%.

  5. Preterm Labor • Definition: Cervical change before 37 weeks of gestation due to regular contractions. • Causes ?!?!?!?!

  6. Pretem Labor: • Risk Factors Multifetal gestation Prior preterm birth Preterm uterine contractions Premature rupture of membranes

  7. PretemLabor: • Risk Factors Behavioral . Low maternal pre-pregnancy weight . Smoking . Substance abuse . Short inter-pregnancy interval

  8. Pretem Labor: • Risk Factors: Vaginal bleeding Urinary tract infections Genital tract infections Periodontal disease

  9. Prediction of Preterm Labor • Recognize the signs and symptoms: . Menstrual-like cramps . Low, dull backache . Abdominal/ Pelvic pressure . Increase or change in vaginal discharge.

  10. Prediction of Preterm Labor • Cervical change: • Short cervix detected by ultrasound has the most value with people that are high risk patients (had a previous preterm delivery or have an anatomic defect of the crevix). • Early dilation and effacement of the crevix

  11. Prediction of Preterm Labor • Other modalities that showed no benefit in improving outcomes of pregnancy in asymptomatic women: • FFN • Bacterial vaginosis • Home uterine contraction monitoring

  12. Prevention of Preterm Labor • Historically nonpharmacologic interventions such as bed rest, abstention from intercourse and hydration were recommended; Evidence for the effectiveness of these interventions is lacking, and adverse effects have been reported.

  13. Prevention of Preterm Labor • There are currently no uniformly effective interventions toprevent preterm labor , regardless of risk factors.

  14. Prevention of Preterm Labor • Treatments that have been proved to affect outcome - 17OH caproate progesterone for patients with history of preterm delivery. - Progesterone for short cervix - Antenatal corticosteroids Betamethasone or Dexamethasone - Targeted use of magnesium sulfate for fetal neuroprotection.

  15. Evaluation of a Patient With Suspected Preterm Labor • History & Physical • Place patient on the external monitor • Ultrasound • Cervical evaluation - if PPROM use sterile speculum exam • Collect cultures including GBS, GC and perform a wet mount to rule out BV.

  16. Management of Patients with Preterm Labor • Purpose in treating preterm labor is to delay delivery if possible until fetal maturity is attained. • Corticosteroids up until 34 weeks. • Tocolysis: Stopping contractions. • Magnesuim Sulfate for neuroprotection up until 32 weeks. • Possible amniocentesis if infection is suspected.

  17. Contraindications to Tocolysis • Intrauterine fetal demise • Lethal fetal anomaly • Nonreassuring fetal status • Severe preeclampsia or eclampsia • Maternal bleeding with hemodynamic instability • Chorioamnionitis • Preterm premature rupture of membranes* • Maternal contraindications to tocolysis (agent specific)

  18. Premature Rupture of Membranes • PROM is the rupture of the chorioamniotic membrane before the onset of labor; happens with about 8% of term pregnancies.

  19. Preterm PROM • PPROM, defined as PROM that occurs before 37 weeks of gestation, associated with 30% of preterm deliveries. • Major complication is intrauterine infection. • Consequences of PPROM depend on gestational age. • <22 weeks associated with incomplete alveolar development.

  20. PROM; Etiology • Infections • Smoking; two fold increase • Short cervix • Previous preterm labor • Polyhydramnios • Multiple gestations • Threatened abortion

  21. Chorioamnionitis • Fever > or = 100.5 • Fundal tenderness • Tachycardia ( maternal and fetal) • Treatment is antibiotics and prompt delivery

  22. ROM diagnosis • Nitrazine test, amniotic fluid PH is above 7.1 turns blue • Fern test • Pooling • Ultrasound?role • Carmine dye

  23. Evaluation and management • History and Physical exam • Sterile speculum exam, collect vaginal cultures. GC-C, GBS. • Ultrasound

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