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    PRETERM LABOUR DR - ERTEQA

    Uploaded by

    Mihraban Omer

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    PRETERM LABOUR DR - ERTEQA

    Uploaded by

    Mihraban Omer
    3 views24 pages

    Original Title

    PRETERM LABOUR Dr.ERTEQA

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    3 views24 pages

    PRETERM LABOUR DR - ERTEQA

    Uploaded by

    Mihraban Omer

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 24

    PRETERM LABOUR

    • Dr.ERTEQA MOHAMED
    DEFINITION
    • Preterm labor occurring 24w - 36w+6 days
    • It is either :
    Indicated preterm birth
    Spontaneous preterm birth
    CAUSES OF PRETERM LABOUR

    1 IDIOPATHIC :70%
    2.MEDICAL AND OBSTETRIC CAUSES:
    • Preeclampsia. • Uterine causes :
    • Placenta Previa anomaly, fibroid .
    • abruptio placentae. • Cervical incompetence
    • Multiple birth . • Trauma or surgery
    • Polyhydramnios • Immunological disorder
    as antiphospholipid Ab
    • Fetal anomaly syndrome
    • Fetal death. • DES exposure
    • Previous second
    trimester abortion or
    induced abortion.
    3.GENETIC FACTORS:

    Genetic factor may have a role since


    PTL runs in families and there is
    tendency for recurrence in
    subsequent pregnancy,
    and have different incidence in
    different races.
    4.INFECTION:

    Chorioaminionitis : local infection following


    abnormal bacterial vaginal colonization
    (bacterial vaginosis) cause local release of
    prostaglandin and stimulate uterine
    contractions.
    Systemic infection ; as pyelonephritis is also
    implicated in preterm labor ,TORCH.
    5.LIFESTYLE FACTORS :
    • Age less than 20 years.
    • Poor nutrition.
    • Poor weight gain during pregnancy.
    • Low maternal pre-natal weight gain .
    • Poverty.
    • Smoking.
    • Short stature.
    • Psychological stress.
    RISK AND COMPLICATIONS OF PTL

    Fetal risk;
    1.The risk of underlying fetal
    condition e.g. :- congenital infection
    or anomalies
    2.Fetal intrapartum hypoxia and birth
    trauma
    Early neonatal risk of:
    Difficulty in maintaining body temperature.
    Difficulties in oral feeding.
    Increased risk of infection.
    Lung immaturity proportionate to the gestational
    age
    Congestive heart failure (PDA).
    Liver immaturity and sever neonatal jaundice
    with increased neurotoxic effects of
    unconjugated bilirubin.
    Intracranial hemorrhage.
    Necrotizing enterocolitis.
    Prediction Screening for
    PTL
    1.PAST OBSTETRIC HISTORY

    If woman has a single previous


    PTL increases the risk of PTL
    4times when compared with
    –ve such history.
    2. BACTERIAL VAGINOSIS
    • Is abnormality of normal vaginal flora
    characterized by a reduced numbers of
    lactobacilli, higher PH& increased
    numbers of potential pathogens:-
    Gardenerella vaginalis ,bacteriodes
    ,Eschersia coli .
    • There is double risk of preterm delivery
    3. ULTRASOUND MEASUREMENT OF CERVICAL LENGTH

    Normal cervix measures about 35 mm Either


    serial measuring of cervical length in 2nd
    &early 3rd trimester.
    Or single measurement of cervical length at
    18 -22 w.
    At any gestational age there is relationship
    between cervical length &the risk of PTL
    4.Fetal fibronectin (FFN) testing.
    Fetal fibronectin
    (fFN) is glue-like protein binding the choriodecidual
    membranes . Rarely seen in the cervico-vaginal
    secretion between 23-34 weeks . release of fFN
    indicate disruption of the choriodecidual interface
    which can be caused by preterm labor ,infection ,
    stress ,or hemorrhage .
    PREVENTION OF PRETERM DELIVERY:

    1-Life style modification coupled with optimal


    management can reduce the incidence of
    preterm delivery (stop smoking , adequate
    nutrition).
    2-Cervical cerculage : prophylactic cerculage
    in asymptomatic patient with short cervix
    diagnosed by ultrasound or patient with
    history suggestive of cervical
    incompetence.
    3-Progesterone: progesterone has many
    cellular functions which maintain
    pregnancy and it’s withdrawal is a
    prerequisite for labor.
    4-non-steroidal anti-inflamatory drugs
    NSAIDs may be beneficial

    5-Screening and treatment of bacterial


    vaginosis early in pregnant who are high
    risk.
    MANAGEMENT OF PRETERM LABOR:

    History :
    - proper estimation of the gestational age with the regard of
    the previous ultrasonic assessment to confirm that the
    baby is preterm.
    -symptoms of PTL/PROM:
    -Abdominal pain : not necessarily regular .
    -Backache.
    -Leaking liquor .
    -Vaginal discharge/Vaginal bleeding.
    - Underlying condition predispose to PTL:
    medical (UTI ,gastroenteritis), obstetric (APH , previous
    PTL) or fetal (anomaly ,death).
    Examination :
    General : to exclude maternal disease as systemic
    infection , dehydration ,hypertension.
    Abdominal examination:
    -exclude underlying abdominal pathology as
    appendicitis, pyelonephritis .
    -obstetric examination : palpable uterine contraction,
    fundal height , lie , presentation , fetal heart.
    Pelvic examination : to exclude cervical dilatation and
    effacement, rupture of the membrane, infection
    ,bleeding.
    INVESTIGATION :

    • GUE (mid stream)


    • High Vaginal Smear.
    • blood culture is indicated if pyrexia more
    than 38.5.
    • C-reactive protein and ESR in cases of
    rupture of membrane.
    • Abdominal ultrasound.
    TREATMENT:

    Initial treatment :
    - Bed rest in lateral decubitus.
    - external cardiotocographic monitoring .
    - tocolysis.
    - steroid administration.
    TOCOLYTIC DRUGS
    1. Beta- adrenergic agonists.
    Ritodrine,salbutamol,turbutaline.
    2. Mg sulphate .
    3. NSAIDs. Indomethacin,
    4. Ca channel blockers. Nifidipine.
    5. Glyceryl trinitrate. Nitroglycerine patch.
    6. Oxytocin antagonists. Atosiban.
    2.ANTENATAL CORTICOSTEROID:

    Betamethasone and dexamethasone 24 mg


    divided in 2-4 doses
    improve neonatal outcome by reducing
    respiratory distress syndrome , intraventricular
    hemorrhage , necrotizing
    enterocolitis.
    Management of preterm delivery :
    If labour become established certain point are differs
    from delivery of term pregnancy:
    Continuous CTG monitoring (more risk of fetal distress ).
    Delivery of the fetus in their sac is better or to delay
    rupture of the membrane as late as possible in labour
    to protect the fragile fetus from birth trauma.
    caesarean section indicated in preterm breech presentation
    ,preterm twin or higher order multiple pregnancy .
    classical C.S. may be indicated in extreme prematurity.
    Assisted delivery to shorten the second stage of labour
    by forceps not ventouse to reduce the risk of I.C.trauma.

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