1. Infection & Preterm Birth

2. Objectives Understand magnitude of problem of PTB. Gain understanding of role of infection in spontaneous PTB. Overview of clinical decision making and “art” of medicine regarding PTB.

3. Rate of PTB ~ 10% and increasing Primary cause of neonatal morbidity and mortality

5. Economic Impact of PTB

6. Risk Factors for Preterm Delivery Previous obstetric history Race/ethnicity Multiple gestation Incompetent cervix Congenital Anomalies

7. Risk Factors for Preterm Delivery Substance abuse Pre-Pregnancy Weight Stress Maternal Age INFECTION

8. 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

9. Infection & PTB: Pathophysiology Change in flora Localized Inflammatory Reaction Invasion of Amniotic Fluid Fetal Invasion

10. 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

11. Case Study 1 Develops fever and uterine tenderness Contractions increased Vaginal delivery of 800 gm baby boy Severe respiratory distress, multi-organ system failure.

12. Case Study 2 34 yo at 35 weeks with contractions and cervical dilation. Group B Strep isolated from vagina at last prenatal visit.

13. 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.

14. Case Study 3 30 yo at 26 weeks presenting with flu-like illness, rash, vaginal discharge and uterine cramping. Primary Genital Herpes

15. Case Study 3 Intravenous anti-viral medication Tocolytics to relax uterus Contractions continued and membranes ruptured Cesarean delivery of 2.5# infant

16. Case Study 3 Support in NICU IV antivirals Spinal tap Disseminated HSV