Pretem labor
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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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Pretem labor

Pretem Labor

RamzyNakad, MD


Preterm birth

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.


Preterm birth1

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.


Preterm birth2

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%.


Preterm labor

Preterm Labor

  • Definition: Cervical change before 37 weeks of gestation due to regular contractions.

  • Causes ?!?!?!?!


Pretem labor1

Pretem Labor:

  • Risk Factors

    Multifetal gestation

    Prior preterm birth

    Preterm uterine contractions

    Premature rupture of membranes


Pretem labor2

PretemLabor:

  • Risk Factors

    Behavioral

    . Low maternal pre-pregnancy weight

    . Smoking

    . Substance abuse

    . Short inter-pregnancy interval


Pretem labor3

Pretem Labor:

  • Risk Factors:

    Vaginal bleeding

    Urinary tract infections

    Genital tract infections

    Periodontal disease


Prediction of preterm labor

Prediction of Preterm Labor

  • Recognize the signs and symptoms:

    . Menstrual-like cramps

    . Low, dull backache

    . Abdominal/ Pelvic pressure

    . Increase or change in vaginal discharge.


Prediction of preterm labor1

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


Prediction of preterm labor2

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


Prevention of preterm labor

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.


Prevention of preterm labor1

Prevention of Preterm Labor

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


Prevention of preterm labor2

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.


Evaluation of a patient w ith s uspected p reterm labor

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.


Management of patients with p reterm labor

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.


Contraindications to tocolysis

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)


Premature rupture of membranes

Premature Rupture of Membranes

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


Preterm prom

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.


Prom etiology

PROM; Etiology

  • Infections

  • Smoking; two fold increase

  • Short cervix

  • Previous preterm labor

  • Polyhydramnios

  • Multiple gestations

  • Threatened abortion


Chorioamnionitis

Chorioamnionitis

  • Fever > or = 100.5

  • Fundal tenderness

  • Tachycardia ( maternal and fetal)

  • Treatment is antibiotics and prompt delivery


Rom diagnosis

ROM diagnosis

  • Nitrazine test, amniotic fluid PH is above 7.1 turns blue

  • Fern test

  • Pooling

  • Ultrasound?role

  • Carmine dye


Evaluation and management

Evaluation and management

  • History and Physical exam

  • Sterile speculum exam, collect vaginal cultures. GC-C, GBS.

  • Ultrasound


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