Preterm labor and Prematurity
Asheber Gaym M.D.
January 2009
Outline
 Definition of preterm labor
 Discuss etiology of preterm labor
 Describe be diagnosis of preterm
labor
 ...
Definitions and Epidemiology
 Preterm labor- onset of labor before 37
completed weeks and after the 20th week of
pregn...
Etiology of Preterm Labor – Risk Factors
Maternal Fetal Others
PROM
Antepartum
hemmorhage
Past history of preterm ...
Diagnosis of Preterm Labor
 Confirmed Gestational Age <37
completed weeks and
 Regular, painful, rhythmic uterine
co...
Complications of Preterm Labor
Maternal Perinatal (Complications of Prematurity)
Increased risk of
caesarean delivery ...
Outline of Management of Preterm Labor
Manageme
nt
Specifics for preterm delivery
General
labor
managemen
t
Same a...
Outline of Management of Preterm Labor
Management Specifics for preterm delivery
Neonatal Intensive
Care
Should be arr...
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Preterm labor and prematurity2

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Published on: Mar 4, 2016
Published in: Health & Medicine      
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Transcripts - Preterm labor and prematurity2

  • 1. Preterm labor and Prematurity Asheber Gaym M.D. January 2009
  • 2. Outline  Definition of preterm labor  Discuss etiology of preterm labor  Describe be diagnosis of preterm labor  List complications of preterm labor  Outline management of preterm labor Asheber Gaym,2009 2
  • 3. Definitions and Epidemiology  Preterm labor- onset of labor before 37 completed weeks and after the 20th week of pregnancy.  Affects 10% of pregnancies on average.  Preterm labor is the commonest cause of preterm birth which leads to the prematurity, responsible for 80-90% of perinatal mortality in the developed world. This makes prevention of preterm labor a major focus of obstetric care is these settings.  Early diagnosis, short term tocolysis and appropriate management of delivery assist to reduce perinatal morbidity and mortality.  Preterm birth results from preterm labor and delivery or preterm pregnancy termination as part of the management of high risk of pregnancies. Asheber Gaym,2009 3
  • 4. Etiology of Preterm Labor – Risk Factors Maternal Fetal Others PROM Antepartum hemmorhage Past history of preterm labor Pre eclampsia/eclampsia Uterine myoma Smoking Cocaine, heroin use Anemia RH Isoimmunization Low socioeconomic status Sexually transmitted infections Multiple pregnancy Polyhydramnios Idiopathic – majority Subclinical chorioamnionitis Iatrogenic- CST, ECV, Amniocentesis, PUBS Asheber Gaym,2009 4
  • 5. Diagnosis of Preterm Labor  Confirmed Gestational Age <37 completed weeks and  Regular, painful, rhythmic uterine contractions recurring at least twice in 20 minutes plus  A cervical dilatation of at least 2 cms or  Ruptured membranes or  Cervical effacement of > 80% or  Documented cervical change during follow up Asheber Gaym,2009 5
  • 6. Complications of Preterm Labor Maternal Perinatal (Complications of Prematurity) Increased risk of caesarean delivery Complications of tocolytic drugs Respiratory Distress Syndrome Intraventricular hemmorhage Necrotizing enterocolitis Retrolental fibroplasia Bronchopulmonary dysplasia Feeding problems ( absence or reduced sucking reflex) Neonatal infection and sepsis – reduced resistance to infection Birth trauma Hypothermia Hypoglycemia, hypocalcaemia, hypomagnesaemia, hyperbilirubinemia Perinatal asphyxia Long term neurologic sequel Asheber Gaym,2009 6
  • 7. Outline of Management of Preterm Labor Manageme nt Specifics for preterm delivery General labor managemen t Same as any labor management Tocolysis Cervix <4 cms, fetal well being ok, no fetal distress, immature fetus tocolytic drugs may be administered to delay labor for as long as possible. Could be short term tocolysis for few days until lung maturation agents are administered or long term tocolysis if successful. Intrapartum fetal well being monitoring More intensive as the risk of fetal distress and asphyxia is higher than term labor. Atraumatic vaginal delivery The risk of fetal trauma during delivery is much higher for the preterm fetus. Thus all attempts must be made to effect an atraumatic delivery including a generous episiotomy; prophylactic forceps delivery; avoid ventouse delivery and gentle handling during delivery. Asheber Gaym,2009 7 Steroid If short term tocolysis is successful, steroid administration
  • 8. Outline of Management of Preterm Labor Management Specifics for preterm delivery Neonatal Intensive Care Should be arranged beforehand. Delivery should be effected in a facility with NICU. Preferably referral should be of the mother before delivery rather than referring a premature neonate Traditional management techniques Bed rest Fluid rehydration- 1-2 L of crystalloid/colloid administered Analgesics/sedatives administration Choice of tocolytic agents 1st line – Beta mimetics (e.g. Ritodrine ); Magnesium sulphate 2nd line- Prostaglandin synthase inhibitors (e.g. Indomethacine) ; Smooth muscle relaxants ( e.g. Nifedipine) Asheber Gaym,2009 8

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