Preterm Labor ? ?

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Preterm Labor? ?

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epidemiology

• Labor and delivery between 28 366 weeks
• 5-10
• be the leading cause of perinatal morbidity and
  mortality
• Survival rates have increased and morbidity has
  decreased because of technologic advances

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Risk Factors

• Previous preterm delivery
• Low socioeconomic status
• Maternal age lt18 years or gt40 years
• Preterm premature rupture of the membranes
• Multiple gestation
• Maternal history of one or more spontaneous
• second-trimester abortions
• Maternal complications (medical or obstetric)
• --Lack of prenatal care

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• Uterine causes
• Myomata (particularly submucosal or subplacental)
• Uterine septum
• Bicornuate uterus
• Cervical incompetence
• Abnormal placentation

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• Infectious causes
• Chorioamnionitis
• Bacterial vaginosis
• Asymptomatic bacteriuria
• Acute pyelonephritis
• Cervical/vaginal colonization
• Fetal causes
• Intrauterine fetal death
• Intrauterine growth retardation
• Congenital anomalies

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diagnosis

• cervical effacement and/or dilatation
• increased uterine irritability before 37 weeks
  of gestation
• forecast
• uterine activity monitoring.
• Ultrasound Examination of Cervical length
• Fetal Fibronectin

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treatment

• Bed Rest
• Tocolysis
• Corticosteroid Therapy
• Antibiotic Therapy

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• Although bed rest is often prescribed for women
  at high risk for preterm labor and delivery,
  there are no conclusive studies documenting its
  benefit.
• A recent meta-analysis found no benefit to bed
  rest in the prevention of preterm labor or
  delivery.

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• Tocolytic therapy may offer some short-term
  benefit in the management of preterm labor.
• A delay in delivery can be used to administer
  corticosteroids to enhance pulmonary maturity and
  reduce the severity of fetal respiratory distress
  syndrome,

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• also be used to facilitate transfer of the
  patient to a tertiary care center
• No study has convincingly demonstrated an
  improvement in survival, long-term perinatal
  morbidity or mortality, or neonatal outcome with
  the use of tocolytic therapy alone.

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• Tocolytic Therapy
• Magnesium sulfate (Intracellular calcium
  antagonism)
• Terbutaline (Bricanyl) Beta2-adrenergic receptor
  agonist sympathomimetic decreases free
  intracellular calcium ions
• Ritodrine (Yutopar) Same as terbutaline
• Nifedipine (Procardia) Calcium channel blocker
• Indomethacin (Indocin) Prostaglandin inhibitor

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• Potential Complications Associated With the Use
  of Tocolytic Agents
• Magnesium sulfate
• Pulmonary edema
• Profound hypotension
• Profound muscular paralysis
• Maternal tetany
• Cardiac arrest
• Respiratory depression

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• Beta-adrenergic agents
• Hypokalemia
• Hyperglycemia
• Hypotension
• Pulmonary edema
• Arrhythmias
• Cardiac insufficiency
• Myocardial ischemia
• Maternal death

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• Indomethacin (Indocin)
• Renal failure
• Hepatitis
• Gastrointestinal bleeding
• Nifedipine (Procardia)
• Transient hypotension

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• Corticosteroid Therapy
• Dexamethasone and betamethasone
• for fetal maturation reduces mortality,
  respiratory distress syndrome and
  intraventricular hemorrhage in infants between 28
  and 35 weeks of gestation.
• benefits start at 24 hours and last up to seven
  days after treatment
• The potential benefits or risks of repeated
  administration of corticosteroids after seven
  days are unknown.

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• women who received antibiotics sustained
  pregnancy twice as long as those who did not
  receive antibiotics
• had a lower incidence of clinical amnionitis.
• poor fetal outcome (death, respiratory distress,
  sepsis, intraventricular hemorrhage or
  necrotizing colitis) occurred less frequently in
  women receiving antibiotics