1 / 44

Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy

Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy. Women Hospital , School of Medical, ZheJiang University Yang Xiao Fu. Preterm labour. Preterm labour.

srollins
Download Presentation

Premature Delivery Premature Rupture of Membrane Prolonged Pregnancy, Multiple Pregnancy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Premature Delivery Premature Rupture of MembraneProlonged Pregnancy, Multiple Pregnancy Women Hospital , School of Medical, ZheJiang University Yang Xiao Fu

  2. Preterm labour

  3. Preterm labour • Defined as delivery after gestation 28 completed weeks till 37 weeks (196-258 days). Birth weight 1000g - 2449g • Preterm labour makes up 5% - 15% of total number of delivery • Can the lower limit of preterm labour be brought earlier to 20 weeks gestation?

  4. Classification • Spontaneous preterm labor • Preterm prematurely ruptured membranes • Preterm birth for medical and obstetrical indications

  5. Diagnosis of preterm labour • Labour occurring between gestation 28 completed weeks and 37 weeks • regular uterine contraction:≥ 4 times in 20 minutes or 8 times in 60 minutes • cervical shortening of ≥ 80% • progressivecervical dilatation of 1cm and above

  6. Prediction of preterm labour • Ultrasound assessing cervical length and internal os funnel formation, when internal os funnel is longer than the total cervical length by 25%, or total cervical length <2.5cm, indicating high possibility of preterm labour

  7. Treatment • Bed rest • Corticosteroids • Tocolysis • Antibiotics • Conduct of labor & delivery

  8. Treatment • Tocolysis ß-adrenergic receptor agonists magnesium sulfate atosiban calcium-channel blockers prostaglandin inhibitors

  9. Premature rupture of membrane

  10. Premature rupture of membrane • Membrane rupture occurring before labour, known as premature rupture of membrane (PROM) • Occurring after 37 completed weeks gestation, is called premature rupture of membrane at term • Occurring before 37 weeks gestation, called preterm premature rupture of membrane (PPROM)

  11. Etiology • Maternal infection • Hydramnios • Cervical incompetency • Nutritional deficit • Others(amniocentesis, sexual behavior)

  12. Clinical Findings and Diagnosis • Sudden gush of fluid or continued leakage • Amniotic fluid in the posterior fornix • Nitrazine test • Ferning • IGFBP-1 • Amnioscopy • Ultrasound

  13. Effect to mother and fetus • Feto-maternal infection • Placenta abruptio • Premature infant: 30% - 40% of premature labour is associated with premature rupture of membrane • Cord prolapse, cord compression • Poor fetal lung development and fetal compression syndrome

  14. Treatment • Term pregnancy without amnionitis expectment management labor induction

  15. Treatment • Preterm pregnancy without amnionitis expectment management best rest antibiotics tocolysis corticosteroids termination of pregnancy

  16. Post-term pregnancy Prolonged pregnancy

  17. Prolonged pregnancy • Gestation at or beyond 42 weeks gestation (>=294 days), known as post-term pregnancy • Important factor for fetal distress, meconium aspiration syndrome, maturation disturbance syndrome, newborn asphysia, perinatal death, macrosomia and dystocia

  18. Diagnosis • Determine gestational age • Calculation based on last menstrual period • Calculation based on ovulation • Ultrasound examination to ascertain gestation age • Period of manifestation of early pregnancy symptoms, quickening • First trimester pelvic examination assessing uterine size

  19. Diagnosis • Assess placental function • Fetal movement count • Fetal electronic monitoring • Fetal biophysical profile (Ultrasound) • amnioscopy

  20. Management • Prevent post-term labour, effectively manage at term • Decide appropriate mode of delivery based on integrated analysis of placental function, estimated fetal weight, cervical effacement, etc • Preinduction cervical ripening • Induced labour • Caesarean section • Neonatal resuscitation

  21. Multiple pregnancy

  22. Multiple pregnancy • Conception of 2 or more fetuses in the same intra-uterine pregnancy • Incidence of multiple pregnancy: 1:80n-1 (n represents number of fetus in a single pregnancy)

  23. Dizygotic twin • Dizygotic twin makes up 70% of twin pregnancy • Associated with ovulation induction, multi-embryo intrauterine transplantation and genetic factors • Two separate ova being fertilized forming two zygotes, each genetic compositions is not identical, hence the differences in both fetuses

  24. Dizygotic twin • The placentas are usually dichorionic, can be fused together, but each has own independent blood circulation • Two amniotic cavities • two layers of amniotic membrane • two layer of chorionic membrane

  25. Monozygotic twin • Monozygotic twin makes up approximately 30% of twin pregnancy • Unclear cause, higher incidence in older pregnant women • Single fertilized ovum differentiating into two fetuses, thus gender, blood type and other phenotypes are identical • As the fertilized ovum differentiates at different times, forming 4 types

  26. Diamniotic dichorionic monozygotic twin • Differentiate within 72 hours of fertilization • Form two independent fertilized ova and two amniotic sac, two layers of chorionic membranes and two layers amniotic membranes within the amniotic sacs • Maybe single or two placentas • Makes up approximately 30% of monozygotic twins

  27. Diamniotic monochorionic monozygotic twin • Differentiation occurs from 72 hours to 8 days of fertilization • One layer of chorionic membranes and two layers of amniotic membranes within two amniotic sacs • Single placenta • Makes up 68% of monozygotic twins

  28. Monoamniotic monochorionic monozygotic twin • Differentiation within 9-13 days after fertilization • Both fetuses share a single amniotic cavity • Single placenta • Makes up 1% - 2% of monozygotic twins

  29. Conjoined twin • Differentiation after 13 days of fertilization, during which the primitive embryo has formed, the body cannot completely differentiate into two separate bodies, thus leading to different types of conjoined twins • Incidence is 1/1500 of monozygotic twins

  30. Conjoined twin

  31. TRAPS

  32. Complication • Pregnant women • Anaemia • Hypertensin in pregnancy • Hydramnios and Premature rupture of membrane • Placental abruption • Uterine atony • Postpartum hemorrhage

  33. Complication • Perinatal infant • Preterm labor • Abnormity of umbilical cord • Head-locking • Anomaly • Selective FGR • TTTS

  34. Management • Treatment of pregnancy • Monozygotic twin laser/RFA • Indication for termination of pregnancy • Timing of pregnancy termination • Treatment in delivery

  35. THANKS

More Related