Presentation on theme: "Infection & Preterm Birth. Objectives Understand magnitude of problem of PTB. Gain understanding of role of infection in spontaneous PTB. Overview of."— Presentation transcript:
Risk Factors for Preterm Delivery Previous obstetric history Race/ethnicity Multiple gestation Incompetent cervix Congenital Anomalies
Risk Factors for Preterm Delivery Substance abuse Pre-Pregnancy Weight Stress Maternal Age INFECTION
Infection and PTB 40% of PTB due to infection ↓ Gestational Age Infection Only pathologic process with firm causal link established Fetal infection & inflammation Cerebral palsy & chronic lung disease
Infection & PTB: Pathophysiology Change in flora Localized Inflammatory Reaction Invasion of Amniotic Fluid Fetal Invasion
Case Study 1 24 yo at 23 weeks EGA with gush of fluid Bacterial vaginosis diagnosed on vaginal exam Admitted, antibiotics started, counseled Family opts for expectant management
Case Study 1 Develops fever and uterine tenderness Contractions increased Vaginal delivery of 800 gm baby boy Severe respiratory distress, multi-organ system failure.
Case Study 2 34 yo at 35 weeks with contractions and cervical dilation. Group B Strep isolated from vagina at last prenatal visit.
Case Study 2 Amniocentesis showed mature fetal lungs Antibiotics continued Vaginal delivery Baby weighted 5#5oz; stayed in nursery for 5 days then discharged to home. No long term sequelae.
Case Study 3 30 yo at 26 weeks presenting with flu-like illness, rash, vaginal discharge and uterine cramping. Primary Genital Herpes
Case Study 3 Intravenous anti-viral medication Tocolytics to relax uterus Contractions continued and membranes ruptured Cesarean delivery of 2.5# infant
Case Study 3 Support in NICU IV antivirals Spinal tap Disseminated HSV