2Preterm BirthDefinition: 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.
3Preterm BirthAccount 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.
4Preterm 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%.
5Preterm LaborDefinition: Cervical change before 37 weeks of gestation due to regular contractions.Causes ?!?!?!?!
10Prediction of Preterm Labor Recognize the signs and symptoms:. Menstrual-like cramps. Low, dull backache. Abdominal/ Pelvic pressure. Increase or change in vaginal discharge.
11Prediction 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
12Prediction of Preterm Labor Other modalities that showed no benefit in improving outcomes of pregnancy in asymptomatic women:FFNBacterial vaginosisHome uterine contraction monitoring
13Prevention 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.
14Prevention of Preterm Labor There are currently no uniformly effective interventions toprevent preterm labor , regardless of risk factors.
15Prevention 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 corticosteroidsBetamethasone or Dexamethasone- Targeted use of magnesium sulfate for fetal neuroprotection.
16Evaluation of a Patient With Suspected Preterm Labor History & PhysicalPlace patient on the external monitorUltrasoundCervical evaluation- if PPROM use sterile speculum examCollect cultures including GBS, GC and perform a wet mount to rule out BV.
17Management of Patients with Preterm 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.
19Contraindications to Tocolysis Intrauterine fetal demiseLethal fetal anomalyNonreassuring fetal statusSevere preeclampsia or eclampsiaMaternal bleeding with hemodynamic instabilityChorioamnionitisPreterm premature rupture of membranes*Maternal contraindications to tocolysis (agent specific)
20Premature Rupture of Membranes PROM is the rupture of the chorioamniotic membrane before the onset of labor; happens with about 8% of term pregnancies.
21Preterm PROMPPROM, 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.
22PROM; Etiology Infections Smoking; two fold increase Short cervix Previous preterm laborPolyhydramniosMultiple gestationsThreatened abortion
23Chorioamnionitis Fever > or = 100.5 Fundal tenderness Tachycardia ( maternal and fetal)Treatment is antibiotics and prompt delivery