 Definition  Epidemiology  Risk factors  Screening  Diagnosis  Prevention  Management

 The occurrence of regular uterine contraction associated with cervical changes (dilation and effacement) after the age of viability and before 37 completed weeks from LMP.  Means ?  Different from threatened PTL ?

 PTB is the leading cause of fetal morbidity and mortality  PTB is increasing in incidence by US statistics from 11% to 12% in the last 5 years  PTB accounts for about 85% of peri-natal morbidity and mortality  2/3 rd of PTB associated with PROM

 Maternal-related : 1. Age: lowest incidence in years 2. Race: 2x in blacks 3. Weight: 3x more if < 50 kg 4. Increases with smoking, alcohol, coitus

 Previous History: 1. History of abortions 2. Uterine abnormalities 3. Previous pregnancy bleeding

 Present complications: 1. Uterine over distention 2. Congenital abnormalities 3. Threatened abortion 4. Maternal illness * 5. IUCD  Genital tract infection *

 The most comprehensive and used tests: 1. Fetal Fibronectin Testing 2. Cervical sonographic asseements Some about comp ?

 Produced from disruption of chorio- decidual structure in these circumstances: 1. Pre-term labour 2. Infection 3. Stress&hemmorhage  When its +ve this increases the risk of PTL  Helpful in ? Not in JUH..

 High sensitivity  High positive predictive value ? Compare with FF  The whole aim is to check the cervical length: o If the cervix length is less than/equal 1.5 cm there is high risk of pre-term labour

 The criteria for diagnosis : 1. Regular uterine contractions  4 contractions in each 20 minutes 2. Cervical changes  Dilatation >= 2cm  Effacement > 80%  In threatened PTL only one of the above presents

 Cevical cerclage  Progestrone  Detection and treatment of vaginal and intrauterine infection  NSAIDS

 The whole aim is to stop labour so the contraindications to management and inhibition of labor :  Absolute: 1. Fetal death 2. Chorioamnionitis 3. Fetal / Maternal indication

 Relative: 1. IUGR 2. Pre-eclampsia 3. Vaginal bleeding 4. Cervial dilatation > 4cm To sum up ?

 B-agonist  Prostaglandins synthetase inhibitor  Mgso4 *  Calcium channel blocker *  Oxytocin antagonist - Atosiban

 Dose: 5-8 mg/dl  Side effects: 1. Respiratory depression 2. Decrease temperature 3. Flushes  Monitoring: 1. RR 2. Deep tendon reflexes 3. Urine output 4. Blood level

 Good To Know: Has a neuro-protective effect against cerebral palsy so it’s the becoming leading drug in the treatment of PTL

 Promotes the release of surfactant from type 2 pneumocytes  Effect last for one week  Don’t give multiple courses

 Don’t give antibiotics in PTL without PROM The incidence of cerebral palsy increases with the use of erythro/clindamycin as estimated by the ORACLE 2 study.

FINITO Done by Ala’ Hawwa