? ? Preterm labor

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? ? Preterm labor

• ???????20-36? (GAlt37?),???????20??4???,?1??6???,?
  ????????????????? (???,??),???????????????2???????
  ,?80 ????? (cervical dilatation gt2cm,cervical
  effacementgt80),???????? (preterm
  labor)????????????,????????,????????? (preterm
  contraction, premature uterine contraction)?

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• ?????
• ????????5-10????????,?6??????37???,?2??????34??
  ??
• ???????
• ???????????,???????,???????,??????????????????????
  ??????,? fetal monitor???????????

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• ????
• Unknown reason ??????
• Known reason ???25??????????,?????
• ??????(Chorioamnionitis)?
• ??????,?????????,??????
• infection????????,???bacterial vaginosis?-gt
  ??????history of preterm labor???,???bacterial
  vaginosis???????????????
• bacterial products?release IL-1, IL-6,
  TNF-alpha?cytokine,??????????arachidonic acid
  ???prostaglandins E2 and PGF2-alpha,?prostaglandin
  s?uterine contraction???????????platelet
  activating factor??????????????cytokines???,??????
  ????preterm labor?
• ????, ????, ?????
• ??????,?????,?????
• ?????
• Previous history of preterm labour, cervical
  incompetence
• Placenta abruption may precipitate preterm labour
  ?
• Pre-eclampsia ?
• Drug intoxication ?

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• ????
• ???????????????
• 1.?????? (fetal monitor)?
• 2.?????????????? (PV)?
• 3.????????
• 4.???????
• 5.?????
• 6.???????????????,?????,?????,?????????????
• 7.Fibronectin test to determine levels of fetal
  fibronectin in cervical mucus, may give some
  assistance in determining those most at risk of
  delivery within the next 10 days -gt frequently
  confounded

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• ???? ???? (???)
• 1.?????????
• Signs of acute fetal or maternal compromise may
  require immediate delivery maternal
  haemodynamic instability in presence of placenta
  abruption, signs of established chorioamnionitis,
  or evidence if acute fetal compromise ?
• ??????????????????????,???????????
• 2. ????????,??????,????, ?????,???
• ?,?????,??????
• 3. Fetal monitor??????
• ??????????????
• ?????20--30??,????????2--3??30--36?,?????????3--4
  ??
• 4. Cervix bacterial culturepenicillin
  (????clindamycin)
• 
  prophylaxis is recommended?
• 5. PV?????????????,??????????????,?
• ??????????,???????,???,???,???
• Nitrazine and fern test to role out
  membrane rupture?

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• ???? ???? (??)
• No contraindications and labour is not advanced
  (i.e. lt 4 cm dilatation without significant
  effacement).
• ??????????????????????cardiac disease?hyperthyroi
  dism?severe hypertension?DM?acute infectious
  disease?eclampsia?severe preeclampsia,?fetal
  distress???, ????, Placenta abruptio?placenta
  previa??????, Cervix??4cm??.
• The choice is subject of much research.
• The aim of tocolysis is to allow time for the
  steroid administered to take effect. There is no
  evidence that outcome is further improved by
  prolonging tocolytsis beyond 48 hours after
  steroid administration.
•  
• 1.??? - 12wks???progesterone,??12wks?????!

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• 2.???????(ß2-agonist)Ritodrine (Yutopar, smooth
  muscle relaxant,gt 4 months ???? -gt ????????????ß2
  receptor????)
• ??????Yutopar 2 amples(50mg/5ml/Amp)??500ccD5W???
  ,??????l5CC?????,????????20??????15CC?????,???????
  ???????(350ug/min),????????120-140beats/min???????
  ???????80ml/hr??????????,????????,?????????8CC/hr,
  ??????Yutopar??record I/O?
• ???????,???,???,???,?????,??????,????????????????
  ,?????????????
• ???????????????,???,???,????????,????,???????,???
  ?????
• ß1heart, intestine
• ß2uterine myometrium, blood vessel, ????????

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• 3.???MgS04 (membrane stabilizer,
  ?Ca???myometrial neuronal junction and
  sacroplasmic reticulum?receptor,??muscle
  contraction)
• ?????????2Amp??????,?15-20?????(?4g IV slowly
  push in 1520mins),???????2gm MgS04(2gm/hr),??????
  ,???lgm/hr???????????Mg??(????6-8mg/dl),????????
  ??DTR,?????(?????30c.c.)?
• ??? headache?hot flushing?pulmonary
  edema?tetany?nausea?palpitation?dry
  mouth?Diplopia?
• ??? Myasthenia gravis (MG), acute myocardial
  infarction (AMI), renal failure??
• ?? ?????,?Calcium gluconate 1 g IV ????

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• 4.???????Nifedipine, adalat -gt reduce
  myometrial contractility (inhibiting
  intracellular calcium entry, block contraction of
  smooth muscle)
• ???????,orally a starting dose 10 mg/hour,
  falling to 20 mg 6-8 hourly once control of
  contraction ??????????15-90????,???2-3???
• ??? headache, hypotension, flushing, ?CHF,
  aortic stenosis????????
• 5.Indomethacin (cyclo-oxygenase inhibitor,
  anti-prostaglandin)
• orally or as rectal suppositories 1-3 mg/kg body
  weight of the mother ?
• ??? 1.GAgt32wks??????,???Ductus
  arteriosus????fetal circulation (premature
  closure if the fetal arteriosus) ?2.primary
  pulmonary hypertension ?3.???GFR?????oligohydramni
  os ?4.?????NSAID?contraindication??

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• 5.Glyceryl trinitrate pathes (nitric oxide donor,
  reduction in uterine muscle contractility)
• Usage 5 mg path may be replaced by a 10 mg patch
  if contractions are not controlled after 2 hours
  . Once effective control is achieved, the patch
  requires changing after 24 hours .
• ??? headache, tachycardia, flushing .
•  
• 6. Oxytocin antagonist (Atosbian)
• Effect similar to Beta-agonist , but few side
  effects .

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• 7. Steroid
• Tx ????24?32??,Betamethasone12mg IM Q24h for 2
  doses,or dexamethasone 6mg q12h x 4
  doses??appearance of pulmonary surfactant from
  type II pneumocytes,??????,???mortality rate???,
  ?????? (RDS)???,?????? (ICH)???
• Tx effect ??treatment?delivery???????24????,????
  ?????,??????,?????24???7????delivery????,???????24
  ???????????
• ??? pulmonary edema, infection rate?, glucose
  intolerance?
• ?????????,?????,???,?????????????? (asymmetrical
  growth retardation)?

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Thank you for your attention!!