PRETERM LABOUR

? . Preterm birth accounts for 70% of neonatal morbidity, mortality.
? Risk of death or neuro-sensory disability increases with decreasing gestational age.
? In the UK, infant mortality among
? Preterm births was 42/1000 live births in 2005, compared with 5/1000 live births overall.
• Overdistened Uterus associated with multiple pregnancy as twin, triplets or polyhydramnios.
• problems with the uterus, cervix or placenta such as uterine anomalies, cervical incompetence, placental abruption.
• Smoking, alcohol or illicit drugs.
• Certain infections, genital tract like bacterial vaginosis caused by Gardenella vaginalis.
• Being underweight or overweight before pregnancy, or gaining too little or too much weight during pregnancy.
• Stressful life events, such as the death of a loved one.
• Domestic violence or any form of abuse during pregnancy.
• Multiple miscarriages
Specific risks for the preterm neonate:
Preterm infants usually show physical signs of prematurity in reverse proportion to the gestational age. As a result there are medical problems affecting different organ systems.
• Respiratory problems are common; specifically the respiratory distress syndrome (RDS or IRDS).
? . Preterm children are at a greater risk for having poor connectivity between these areas leading to learning disabilities.
? Neurological problems include
? apnea of prematurity,
? hypoxic-ischemic encephalopathy ,
? retinopathy of prematurity ,
? developmental disability,
? cerebral palsy
INVESTIGATIONS Specific for PTL:
Fetal fibronectin:
It is glycoprotein secreted by chorionic cells.
It’s presence in the cervical or vaginal secretions indicates that the border between the chorion and deciduas has been disrupted.
A positive test between 20- 36 weeks indicates an increased risk of preterm birth.
It is normally positive before 20 weeks of gestation and after 36 weeks of gestation
Negative between 20 -36 weeks of gestation.
? Management during Labour:
? First Stage:
? Second Stage:
? Third Stage:
? Indications of Operative delivery;
B- To stop uterine contractions using:
Tocolytic Drugs:
Medications that been used to stop uterine contractions.
It’s also use In the management of intra partum foetal distress and impaired foetal growth and to facilitate external cephalic version at term.
CALCIUM CHANNEL BLOCKERS:
There are two types of calcium channels in the myometrial cell, the L type and the T-type.
Nifedipine binds to the inside of myometrial L-type voltage dependent calcium channels causing them to remain closed, and so inhibits contractility.
dose:20 mg can be 3 times.
Atosiban :antioxytocin
Indomethacin:
Ritoridin :beta agonists.
Progesterone:affect cyclic AMP increase inside the cell.
Mg sulphate act as neuroleptic
Prevention : by dealing with precipitating factors.