Pretem  Labor Ramzy   Nakad

Pretem Labor Ramzy Nakad - Description

, MD. Preterm Birth. Definition: Birth that occurs prior to completion of 37 weeks of gestation.. Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization . ID: 743296 Download Presentation

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Pretem Labor Ramzy Nakad

, MD. Preterm Birth. Definition: Birth that occurs prior to completion of 37 weeks of gestation.. Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization .

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Pretem Labor Ramzy Nakad




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Presentation on theme: "Pretem Labor Ramzy Nakad"— Presentation transcript:

Slide1

Pretem Labor

Ramzy

Nakad

, MD

Slide2

Preterm Birth

Definition: Birth that occurs prior to completion of 37 weeks of gestation.

Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization

.

In the United States, approximately 12% of all live births occur before term, and preterm labor preceded approximately 50% of these preterm

births.

Slide3

Preterm Birth

A

ccount

for approximately 70% of neonatal deaths and 36% of infant deaths as well as 25–50% of cases of long-term neurologic impairment in

children.

Estimated

annual cost of preterm birth in the United States to be $26.2 billion or more than $51,000 per premature

infant.

Slide4

Preterm Birth

Classified into two main categories.

Spontaneous: Approximately 40-50% are due to spontaneous preterm labor with intact membranes and 25-40% due to preterm premature rupture of the membranes.

Indicated: Deliberate intervention for variety of maternal or obstetric indications 20-30%.

Slide5

Preterm Labor

Definition: Cervical change before 37 weeks of gestation due to regular contractions.

Causes ?!?!?!?!

Slide6

Slide7

Pretem Labor:

Risk Factors

Multifetal gestation

Prior preterm

b

irth

Preterm uterine contractions

Premature rupture of membranes

Slide8

Pretem Labor:

Risk Factors

Behavioral

. Low maternal pre-pregnancy weight

. Smoking

. Substance abuse

. Short inter-pregnancy interval

Slide9

Pretem Labor:

Risk Factors:

Vaginal bleeding

Urinary tract infections

Genital tract infections

Periodontal disease

Slide10

Prediction of Preterm Labor

Recognize the signs and symptoms:

. Menstrual-like cramps

. Low, dull backache

. Abdominal/ Pelvic pressure

. Increase or change in vaginal discharge.

Slide11

Prediction of Preterm Labor

Cervical change:

Short cervix detected by ultrasound has the most value with people that are high risk patients (had a previous preterm delivery or have an anatomic defect of the

crevix

).

Early dilation and effacement of the

crevix

Slide12

Prediction of Preterm Labor

Other modalities that showed no benefit in improving outcomes of pregnancy in asymptomatic women:

FFN

Bacterial

vaginosis

Home uterine contraction monitoring

Slide13

Prevention of Preterm Labor

Historically

nonpharmacologic

interventions such as bed

rest, abstention from intercourse

and hydration were recommended;

Evidence for the effectiveness of these interventions is lacking, and adverse effects have been

reported.

Slide14

Prevention of Preterm Labor

There are currently no uniformly effective interventions

toprevent

preterm labor , regardless of risk factors.

Slide15

Prevention of Preterm Labor

Treatments that have been proved to affect outcome

- 17OH

caproate

progesterone for patients with history of preterm delivery.

- Progesterone for short

cervix

-

Antenatal corticosteroids

Betamethasone or Dexamethasone

- Targeted

use of magnesium sulfate for fetal

neuroprotection

.

Slide16

Evaluation of a Patient W

ith

S

uspected

P

reterm Labor

History & Physical

Place patient on the external monitor

Ultrasound

Cervical evaluation

- if PPROM use sterile speculum exam

Collect cultures including GBS, GC and perform a wet mount to rule out BV.

Slide17

Management of Patients with P

reterm Labor

Purpose in treating preterm labor is to delay delivery if possible until fetal maturity is attained.

Corticosteroids up until 34 weeks.

Tocolysis: Stopping contractions.

Magnesuim

Sulfate for

neuroprotection

up until 32 weeks.

Possible amniocentesis if infection is suspected.

Slide18

Slide19

Contraindications to

Tocolysis

Intrauterine

fetal demise

Lethal fetal anomaly

Nonreassuring

fetal status

Severe preeclampsia or

eclampsia

Maternal bleeding with hemodynamic instability

Chorioamnionitis

Preterm premature rupture of membranes*

Maternal contraindications to

tocolysis

(agent specific)

Slide20

Premature Rupture of Membranes

PROM is the rupture of the

chorioamniotic

membrane before the onset of labor; happens with about 8% of term pregnancies.

Slide21

Preterm PROM

PPROM, defined as PROM that occurs before 37 weeks of gestation, associated with 30% of preterm deliveries.

Major complication is intrauterine infection.

Consequences of PPROM depend on gestational age.

<22 weeks associated with incomplete alveolar development.

Slide22

PROM; Etiology

Infections

Smoking; two fold increase

Short cervix

Previous preterm labor

Polyhydramnios

Multiple gestations

Threatened abortion

Slide23

Chorioamnionitis

Fever > or = 100.5

Fundal tenderness

Tachycardia ( maternal and fetal)

Treatment is antibiotics and prompt delivery

Slide24

ROM diagnosis

Nitrazine

test, amniotic fluid PH is above 7.1 turns blue

Fern test

Pooling

Ultrasound?role

Carmine dye

Slide25

Slide26

Slide27

Evaluation and management

History and Physical exam

Sterile speculum exam, collect vaginal cultures. GC-C, GBS.

Ultrasound

Slide28

Slide29