Preterm Labor

1
Preterm Labor ? ?

• Lin Jianhua M.D., Ph.D., Professor
• 
  Department Of Obstetrics Gynecology
• Renji
  Hospital Affiliated to SJTU School of Medicine

2
(No Transcript)
3
(No Transcript)
4
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

5
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

6

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

7

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

8
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

9
treatment

• Bed Rest
• Tocolysis
• Corticosteroid Therapy
• Antibiotic Therapy

10

• 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.

11

• 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,

12

• 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.

13

• 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

14

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

15

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

16

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

17

• 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.

18

• 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

19
THANKS FOR YOUR ATTENTION
Lin Jianhua M.D., Ph.D., Professor Dep. of
Obstet. Gynecol. Renji Hospital Affiliated to
SJTU School of Medicine