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Pretem birth and prematae rptured of memb Dr.Nawal Al Sinani

Pretem birth and prematae rptured of memb Dr.Nawal Al Sinani. Preterm birth. is delivery befor 37 completed weeks it is the reason for 2/3 of fetal death . in first year of live . The over all infant mortality has continued to decline but the mortality associated with preterm birth is not.

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Pretem birth and prematae rptured of memb Dr.Nawal Al Sinani

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  1. Pretem birth and prematae rptured of memb Dr.Nawal Al Sinani

  2. Preterm birth. is delivery befor 37 completed weeks it is the reason for 2/3 of fetal death . in first year of live .The over all infant mortality has continued to decline but the mortality associated with preterm birth is not.

  3. Long term out comes. The high rate of significant neonatal morbidity in these immature neonates and diminished likelilhood of normal life must be weighed against the apparent triumph of survival studies showed that follow up of neonat born at 24 -26 wks . Report that only 20% totally free of impairment at 5 y Theye are usually has disabilities in mental and psychomotor develapment neuromotor function’sensory and communication function.

  4. Economic impact. They found that more than a1/3 of mony expended for infant health care during the first year of life is spent on the 7% of neonates born who weigh less than 2500gm .additional expenditures for developmental handicaps during the remainder of childhood should also be considered.

  5. Causes of preterm birth . Medical and obstetrical complications. PET . Fetal distress. IUGR. APH

  6. LIFE STYLE FACTORS. Smoking ,drug use Extreem of age Poverty Vit c deficiency Heavy work Long working hours.

  7. GENETIC FACTORS • Recurrent familial and racial nature of preterm birth has lead to suggestion that genetics may play a causal role • Gene for decidual relaxin . • Fetal mitochondrial trifunctional protein defects • Polymorphism in the interleukin-1 gene complex • B2 adrenergic receptor defct.

  8. Chorio amnionitis. The pathway of bacteria to enter the (A.F) with intact memb. Is unclear E.coli can permeate living memb. Bacterial endotoxin stimulate decidual monocytes to produce cytokines which stimulat arachidonic acid and prosta glandins E2&F2 alph

  9. Bacterial vaginosis. Lacto bacillus ( release hydrogeen Replaced with anaerobes peroxide)

  10. Periodontal disease Oral bacteria especially Fusobacterium Increase the preterrm labor by 7 fold.

  11. Fetal fibronection • Glycoprotein. • Releas by fetal amnion. • Present in high conc. in maternal blood &A.F • It is thought to playaroule in placenta adhesion to the decidua • Present of fibonectin. • In cenvico vaginal secretion prior to memb • Rupture is possible marker for impending preterm laber. • (th predictive value for the delivery . Within 1wk in 30%)

  12. Admission to L /R • Diagnosis of rupture memb. • Sterile speculum ex • Nitruzine test (pH of A.F 7-7.5 ) • False postive ( blood ,semen ,bacteral vaginosis ) • Ferning test (Na .chlorid) • If the pt .less than34 wks • Start Antibiotic , fetal heart monitring • Beta methasone 12mg im 24 hr apart OR dexamethasone 5mg /12hr (4doses ) Management preterm rupture of memb .&preterm labor.

  13. Management of preterm labor with intact memb. • Ademissiom to L/R • Corticosteirod therapy thyrotropin releasing hormone (enhances surfactant synthesis) • anti micrbials(clindamycin) • Bed rest hydration&sedation

  14. TOCOLYTIC B-adrenergic receptor agonists . Ritodrine Delay deliviry for 48hr S.E ( pulmonary oedema ,hyper glycemia ,hypokalemia ,arrhythmia, myocardial,ischemia) Magnesium sulfate S.E ( respiratory depression ,diplopia , muscular paralysis ,cardiac arrest ,)

  15. TOCOLYTIC . • (indomethacin ) • In hibit P.G synth .or blocking P.G action on target organs. • S /E( oligohy dramnios ,renal failure) • (Calcium channel blocker) • (NIFEDIPINE) • S/E(hypotension ,decrease placenta perfusion ,fetal hyper capnia ,acidosis ,hypoxia in) • (anti oxytocin)

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